Prothrombin Complex Concentrates in Acquired Hypoprothrombinemia

Sandler, S. Gerald; Rath, Charles E.; Ruder, Avima M.

doi:10.7326/0003-4819-79-4-485

Cited by 33 publications

(12 citation statements)

References 26 publications

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“…As the factor V-deficient plasma used in the assay may also have reduced factor II levels, increases in this following administration of the concentrate could account for the apparent rises in factor V recorded. Other workers have noted that concentrates of factor IX only produce partial correction of the prothrombin time in patients with cirrhosis and have attributed this to the lack of factor V in the preparation (Sandler, Rath, and Ruder, 1973). The rises in factor VII were of interest, as the concentrate only contains small amounts of this clotting factor, but other workers have also noted this effect (Dr Eibl, personal communication).…”

Section: Discussionmentioning

confidence: 97%

The use of fresh frozen plasma or a concentrate of factor IX as replacement therapy before liver biopsy.

Gazzard¹,

Henderson²,

Williams³

1975

Gut

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SUMMARY Thirty patients with various types of chronic liver disease and a prothrombin time prolonged for four or more seconds who required needle liver biopsy for diagnostic purposes were given either fresh frozen plasma or a concentrate of clotting factors as a prophylactic measure.The prothrombin time returned to within normal limits in seven of the 15 patients given the concentrate and in three of those receiving fresh frozen plasma. Levels of factors II, IX, and X showed increases of about 30% following concentrate administration; corresponding rises in the group given fresh frozen plasma were less. This was because of the smaller quantity of clotting factors administered with fresh frozen plasma and the increase in factor II and IX activity/kg body weight/unit of clotting factor injected was greater when fresh frozen plasma was used. In neither group was there clinical evidence of bleeding, but it was of interest that most of the clotting factor levels, except in factor II, before biopsy were above those normally required for haemostasis.No evidence of disseminated intravascular coagulation was found with the concentrate injection, and the most worrying finding was the appearance of HBAg some months later in three patients, two from the concentrate group and one from those given fresh frozen plasma. However, the conversion of these patients to HBAg positive may be unrelated to the clotting factor replacement therapy.The risk of bleeding with a liver biopsy is considered to increase if the prothrombin time is prolonged more than three seconds (Sherlock, 1968). There are, however, some patients with prolonged prothrombin times in whom this investigation is needed for diagnostic purposes. Prophylactic administration of clotting factors would be expected to reduce the risks of bleeding in these patients, and for some years it has been our practice to infuse fresh frozen plasma immediately before liver biopsy. With the development of a concentrate of clotting factors which can be given as a single intravenous injection, the necessity for an indwelling intravenous catheter and the administration of the water and sodium load present in fresh frozen plasma could be avoided. Such concentrates contain a high concentration of clotting factors II, IX and X, the levels of which are all reduced in liver disease (Roberts and Cederbaum, 1972), and in this paper we describe a comparison with fresh frozen plasma in the correction of the coagulation defect in patients with a prolong-

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Section: Discussionmentioning

confidence: 97%

The use of fresh frozen plasma or a concentrate of factor IX as replacement therapy before liver biopsy.

Gazzard¹,

Henderson²,

Williams³

1975

Gut

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“…The triad of symptoms associated with cervico-mediastinal hematoma was reported by Capps et al 1 Upper airway obstruction often accompanies bleeding into the retropharyngeal and submandibular spaces regardless of the cause. 7,23,24,32,33 Patients with early retropharyngeal hematoma can be seen with a sore throat without shortness of breath and may be misdiagnosed with viral pharyngitis. 25 Twelve to 48 hours of bleeding may precede complaints of respiratory embarrassment.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous cervical hemorrhage with near-complete airway obstruction

et al. 1998

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“…In 1968, Tullis et al described the use of PCC containing the factors II, VII, XI, and X, for management of Christmas disease and Stuart-Prower deficiency (Factor X) [29]. Later, case reports appeared regarding the efficacy of PCC for reversal of elevated prothrombin time in patients with warfarin overdosage [30]. In 1976, an early clinical trial was conducted comparing Prothromplex, a commercially available PCC containing factors II, IX, and X, versus Vitamin K for patients with warfarin overdosage.…”

Section: Early Use Of Pccmentioning

confidence: 97%

Prothrombin Complex Concentrates for Oral Anticoagulant Therapy-Related Intracranial Hemorrhage: A Review of the Literature

Bershad

Suárez

2009

Neurocrit Care

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Warfarin-related intracranial hemorrhage carries a high mortality and poor neurological outcome. Rapid reversal of coagulopathy is a cornerstone of medical therapy to halt bleeding progression; however the optimal approach remains undefined. Prothrombin complex concentrates have promising features that may rapidly reverse coagulopathy, but remain relatively unstudied. We aim to review the literature regarding the use of prothrombin complex concentrates in patients with warfarin-related intracranial hemorrhage. A comprehensive review of the literature was conducted using PUBMED and Google Scholar databases to identify the use of PCC in patients with warfarin-related intracranial hemorrhage. The characteristics abstracted included the type of PCC, dosing, study design, type of intracranial hemorrhage, changes in the INR, and adverse effects. Prothrombin complex concentrates are heterogeneous in regards to factor concentration. PCC consistently reversed the INR in patients with intracranial hemorrhage. There is some evidence that PCC may reverse the INR more rapidly compared to fresh frozen plasma. Serious adverse effects were uncommon and included mainly thromboembolism. PCC has features which make it a promising therapy for patients with warfarin-related intracranial hemorrhage, and deserves more rigorous study in prospective-randomized controlled trials.

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Prothrombin Complex Concentrates in Acquired Hypoprothrombinemia

Cited by 33 publications

References 26 publications

The use of fresh frozen plasma or a concentrate of factor IX as replacement therapy before liver biopsy.

The use of fresh frozen plasma or a concentrate of factor IX as replacement therapy before liver biopsy.

Spontaneous cervical hemorrhage with near-complete airway obstruction

Prothrombin Complex Concentrates for Oral Anticoagulant Therapy-Related Intracranial Hemorrhage: A Review of the Literature

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