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Prothrombin complex concentrate (PCC, Octaplex®) in patients requiring immediate reversal of vitamin K antagonist anticoagulation

2012; Elsevier BV; Volume: 129; Issue: 4 Linguagem: Inglês

10.1016/j.thromres.2011.12.007

1879-2472

Madeline Song, Connor P Warne, Mark Crowther,

Poisoning and overdose treatments

Warfarin is the vitamin K antagonist (VKA) used in oral anticoagulant therapy (OAT) for prevention and treatment of thrombosis and is monitored by the international normalized ratio (INR). When immediate reversal of anticoagulation is necessary, vitamin K and fresh frozen plasma (FFP) are administered [ [1] Baker R.I. Coughlin P.B. Gallus A.S. Harper P.L. Salem H.H. Wood E.M. Warfarin reversal consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis. Med J Aust. 2004; 181: 492-497 PubMed Google Scholar ]. Some prothrombin complex concentrates (PCCs) may be more effective than FFP and vitamin K for correction of INR in warfarin-treated patients with life-threatening bleeding [ 2 Makris M. Greaves M. Phillips W.S. Kitchen S. Rosendaal F.R. Preston E.F. Emergency oral anticoagulant reversal: the relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of coagulopathy. Thromb Haemost. 1997; 77: 477-480 PubMed Google Scholar , 3 Baglin T. Management of warfarin (coumadin) overdose. Blood Rev. 1998; 12: 91-98 Abstract Full Text PDF PubMed Scopus (66) Google Scholar ]. A PCC available in Canada is Octaplex®, freeze-dried, solvent/detergent (S/D) treated and nanofiltered to remove pathogens which contains coagulation factors II, VII, IX, and X and proteins C and S at concentrations of 14–38 IU/mL, 9–24 IU/mL, 25 IU/mL, 18–30 IU/mL, 7–31 IU/mL, and 7–32 IU/mL, respectively . According to the National Advisory Committee on Blood and Blood Products, use of this PCC is limited to facilities adequately equipped to evaluate patient symptoms as requiring reversal of anticoagulation [ [4] National Advisory Commitee on Blood and Blood Products. Recommendations for use of prothrombin complex concentrates in Canada. Updated June 29, 2011. Google Scholar ].