Comparative effectiveness of 3- versus 4-factor prothrombin complex concentrate for emergent warfarin reversal

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

“…Activated recombinant activated factor VIIa and PCCs are better than fresh frozen plasma in reversing warfarin 201 ; PCC is better than recombinant activated factor VIIa 202 ; and 4-factor PCC appears to be more effective than 3-factor PCC. 188,203,204 …”

Rapid response to intravenous vitamin K may obviate the need to transfuse prothrombin complex concentrates

“…Plasma may cause fluid overload, allergic reactions, or transfusion‐related acute lung injury and is not efficacious in achieving a rapid decrease in INR. PCCs are very effective in rapidly reversing the INR but are expensive and there is concern regarding postexposure thrombotic events . Hence, use of IV vitamin K alone may be an acceptable approach for CRNMB or when an urgent (<6 hr), but not immediate (<2 hr) procedure is needed.…”

“…When major bleeding or CRNMB occurs it is necessary to temporarily discontinue the warfarin and administer the antidote, vitamin K. Under these circumstances, vitamin K is given intravenously (IV) . In addition, repletion of the vitamin K factors using either plasma or prothrombin complex concentrates (PCCs) is often advocated for an immediate (short‐lived) partial reversal . With the availability of a four‐factor PCC, the use of plasma has declined and the four‐factor PCC shown to be superior .…”

“…With the availability of a four‐factor PCC, the use of plasma has declined and the four‐factor PCC shown to be superior . However, use of a four‐factor PCC can be associated with exposure to tens of thousands of blood donors, allergic reactions, and a risk of thrombosis, varying between 1.5 and 7.8% . Hence, a conservative approach to the use of PCCs may be appropriate, restricting the use of four‐factor PCCs to the more severe, limb or life‐threatening bleeds, such as intracranial, retinal, retroperitoneal, or large‐volume gastrointestinal bleeding.…”

Four-factor prothrombin complex concentrates: effectiveness in the reversal of anticoagulation

“…9 VKA reversal: 3F-PCC vs 4F-PCC Several studies have shown superior efficacy of 4F-PCC compared to 3F-PCC for VKA reversal, with similar safety profiles. [10][11][12] A retrospective study published in 2016 by Mangram et al reviewed all consecutive trauma patients with coagulopathy secondary to oral anticoagulant use who were treated with either 3F-or 4F-PCC over a 4-year period at two trauma centers.…”