Prothrombin complex concentrate

Supplement with fresh frozen plasma (15-20 mL/kg) or prothrombin complex concentrate... 

Factor IX Replacement Hemophilia B therapy may include recombinant (produced via transfection of mammalian cells with the human factor IX gene) or plasma-derived (concentrate from pooled plasma) factor IX (see Table 64-2). Guidelines for choosing the factor-concentrate formulation for hemophilia B are similar to the guidelines for hemophilia A. However, older-generation factor IX concentrates containing other vitamin K-dependent proteins (e.g., factors II, VII, and IX), called prothrombin complex concentrates (PCCs), have been associated with thrombogenic side effects. Consequently, these products are not first-line treatment for hemophilia B.11... 

APCC, activated prothrombin complex concentrate PCC, prothrombin complex concentrate vWF, von Willebrand factor. 

Treatment algorithm for the management of patients with hemophilia A and factor VIII antibodies. BU, Bethesda unit PCC, prothrombin complex concentrate a PCC, activated prothrombin complex concentrate. 

FFP, fresh frozen plasma PCC, prothrombin complex concentrates. 

Immediate administration of 100 meg to 1 mg vitamin K subcutaneously or intravenously, followed by administration of FFP as necessary. Vitamin K administration via the intramuscular route may induce hematoma owing to coagulopathy, and intravenous administration should be slow because it has been associated with anaphylaxis. Prothrombin complex concentrate (PCC) at minimum dose of 50 units/kg should be given for life-threatening bleeding.27,28... 

Yes Yes Hold warfarin therapy. Give 10 mg slow IV infusion, may repeat dose every 12 h, supplement with plasma or prothrombin complex concentrate (PCC). 

II Prothrombin deficiency 30-40% 3 days Prothrombin complex concentrates (intermediate purity factor IX concentrates)... 

VII Factor VII deficiency 30% 4-6 hours FFP Prothrombin complex concentrates (intermediate... 

Sultan Y Loyer F In vitro evaluation of factor VI11-bypassing activity of activated prothrombin complex concentrates and factor Vila in the plasma of patients with factor VIII inhibitors thrombin generation test in the presence of collagen-activated platelets. J Lab Clin Med 1993 121 444-452. 

Prothrombin complex concentrate, cryoprecipitate and fresh frozen plasma, commonly-used coagulation factor products. 

Inhibitor formation has been observed in only a few patients with factor XI deficiency. Like patients with hemophilia A and B, these patients may be treated with prothrombin complex concentrates or recombinant factor Vila (2). 

Penner JA. Management of haemophilia in patients with high-titre inhibitors focus on the evolution of activated prothrombin complex concentrate AUTOPLEX T. Haemophilia 1999 5(Suppl 3) l-9. 

INR over 8.0 with life-threatening hemorrhage withhold the drug and give a prothrombin complex concentrate (such as Beriplex-P/N or Prothromplex-T) 50 U/kg (35) if this is not available, give fresh frozen plasma 15 ml/kg. 

Barthels M. Chnical efficacy of prothrombin complex concentrates and recombinant factor Vila in the treatment of bleeding episodes in patients with factor VII and IX inhibitors. Thromb Res 1999 95(4 Suppl l) S31-8. 

This may explain the effectiveness of treating patients with hemophilia who have inhibitors with high doses of factor VIII. Another approach involves the use of prothrombin complex concentrate to treat bleeding episodes in patients with factor VIII inhibitors (38) however, thromboembolic complications related to higher doses of prothrombin complex concentrate have been described, although these are relatively rare (39,40). Thrombotic events are extremely rare when highly purified factor IX is used. Activated prothrombin complex concentrate is also effective in patients with factor VIII inhibitors (41). Serious complications are rare, but disseminated intravascular coagulation has been reported (42). 

Inhibitor bypassing agents include prothrombin complex concentrates, activated prothrombin complex concentrates (such as FEIBA), porcine factor VIII, and recombinant factor Vila. During 10 years usage of FEIBA (3.95 x 10 FEIBA units infused) a total of 16 thrombotic events were reported, corresponding to an incidence of 4.05 per 10 ... 

Parvovirus B19 transmission occurred in a child who had received vapor heat-treated prothrombin complex concentrate (60° C for 10 hours and 80° C for 1 hour) and in another child who received dry-heated factor VIII concentrate (80° C for 72 hours). Both children had severe hemophiha A and were treated for factor VIII inhibitors (52). 

Chandra S, Brummelhuis HG. Prothrombin complex concentrates for clinical use. Vox Sang 1981 41(5-6) 257-73. 

Cartmill M, Dolan G, Byrne JL, Byrne PO. Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergencies. Br J Neurosurg 2000 14(5) 458-61. 

In 42 patients who required immediate reversal of oral anticoagulant therapy by prothrombin complex concentrate, no laboratory and clinical evidence for coagulation activation was found (7). The authors suggested that the concentration of protein C within the prothrombin complex concentrate is an important factor for preventing thrombosis. The activated form of protein C is an important natural anticoagulant. 

The administration of prothrombin complex concentrate to reverse anticoagulant treatment has been associated with thrombotic complications, such as disseminated intravascular coagulation (8). However, such complications have typically occurred in patients with liver failure or after repeated treatment, such as in patients with hemophilia B treated with prothrombin complex concentrate (9). 

Relative contraindications for prothrombin complex concentrate are liver disease, coronary heart disease, and factors that predispose to thrombosis (11). It is contraindicated in disseminated intravascular coagulopathy and hyperfibrinolysis. 

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