Abstract
Background
Three- and four-factor prothrombin complex concentrates (PCC) are gaining popularity
for acute reversal of vitamin K antagonist-associated bleeding. Although acute thrombosis
after PCC administration has been described, it seems to be rare.
Case Report
An 83-year-old woman on warfarin for history of deep venous thrombosis (DVT) presented
to the Emergency Department with life-threatening gastrointestinal bleeding, requiring
urgent PCC administration. After stabilization, she subsequently developed a new limb-threatening
upper-extremity DVT.
Why Should an Emergency Physician Be Aware of This?
As PCC therapy gains popularity for reversal of anticoagulant-induced bleeding in
urgent bleeding scenarios, the emergency physician must be aware of the complications
of PCC administration, including new limb-threatening DVT.
Keywords
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References
- Evidence based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012; 141: e152S-e185S
- Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergencies.Br J Neurosurg. 2000; 14: 458-461
- Emergency oral anticoagulant reversal: the relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy.Thromb Haemost. 1997; 77: 477-480
- Reversal of target-specific oral anticoagulants.J Thromb Thrombolysis. 2013; 36: 195-202
- Perioperative hemostatic management of patients treated with vitamin K antagonists.Anesthesiology. 2008; 109: 918-926
- Important safety information [package insert].CSL Behring, Kankakee, IL2013 (Available at:) (Accessed November 19, 2014)
UPMC System Pharmacy and Therapeutics Committee. Formulary review: prothrombin complex concentrate (human) (Kcentra®, CSL Behring LLC). Available at: http://emcrit.org/wp-content/uploads/2013/12/Kcentra_4FPCC_SPT.pdf. Accessed November 19, 2014.
- Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists: a meta-analysis.Thromb Haemost. 2011; 106: 429-438
- Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized plasma-controlled, phase IIIb study.Circulation. 2013; 128: 1234-1243
- Suboptimal effect of a three-factor prothrombin complex concentrate (Profilnine-SD) in correcting supratherapeutic international normalized ratio due to warfarin overdose.Transfusion. 2009; 49: 1171-1177
- Clinical experience with three-factor prothrombin complex concentrate to reverse warfarin anticoagulation in intracranial hemorrhage.Stroke. 2012; 43: 2500-2502
- Prothrombin complex concentrate accelerates international normalized ratio reversal and diminishes the extension of intracranial hemorrhage in geriatric trauma patients.Am Surg. 2014; 80: 372-376
- Prothrombin complex concentrates for oral anticoagulant therapy-related intracranial hemorrhage: a review of the literature.Neurocrit Care. 2010; 12: 403-413
- The clinical use of prothrombin complex concentrate.J Emerg Med. 2013; 44: 1201-1210
- How I treat target-specific oral anticoagulant–associated bleeding.Blood. 2014; 123: 1152-1158
- Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study).Crit Care. 2014; 18: R81
- Activated prothrombin complex concentrate factor VIII inhibitor bypassing activity (FEIBA) for the reversal of warfarin-induced coagulopathy.Int J Emerg Med. 2009; 2: 217-225
- A meta-analysis of the efficacy and safety of recombinant activated factor VII for patients with acute intracerebral hemorrhage without hemophilia.J Clin Neurosci. 2010; 17: 685-693
Article info
Publication history
Published online: October 23, 2015
Accepted:
February 17,
2015
Received in revised form:
January 30,
2015
Received:
December 9,
2014
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Target-specific Oral Anticoagulants in the Emergency DepartmentJournal of Emergency MedicineVol. 50Issue 2
- PreviewEmergency physicians make treatment decisions in patients who present to the emergency department (ED) with acute venous thromboembolism (VTE). They also encounter patients on target-specific oral anticoagulants (TSOACs) who require urgent intervention. New approvals and increasing prescriptions for TSOACs (e.g., apixaban, dabigatran, edoxaban, and rivaroxaban) for the management of several thromboembolic disorders warrant an evaluation of the impact of these agents in the ED setting.
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