Usefulness of prothrombin complex concentrate for cardiac injury in patients receiving oral anticoagulant therapy

Use and effectiveness of a two‐level initiation strategy for fixed‐dose prothrombin complex concentrate according to the initial international normalized ratio in an emergency department in Japan

“…Our study revealed that PCC administration for trauma as well as iatrogenic events resulted in satisfactory efficacy in clinical practice. In patients without hypofibrinogenemia (e.g., intracranial hemorrhage, cardiac tamponade, soft tissue injury) in whom mechanical hemostasis cannot be achieved, PCC may be effective even when INR is not elevated 14,15 . In fact, the joint commission stated that for hemorrhagic stroke in the setting of warfarin‐induced coagulopathy, reversal should be initiated for patients with INR over 1.4 17 or 1.35, 5 favoring PCC for reversal, but guidance on dosing for PCC is lacking.…”

“…In addition, its use is limited to patients with INR over 2. However, rapid normalization of INR during hemostatic management is necessary even in patients with critical bleeding who do not meet the treatment criterion 14,15 . Although PCC has emerged as the preferred option in emergency settings, the optimal dosing strategy, especially in Japanese patients, remains unknown.…”

“…However, rapid normalization of INR during hemostatic management is necessary even in patients with critical bleeding who do not meet the treatment criterion. 14,15 Although PCC has emerged as the preferred option in emergency settings, the optimal dosing strategy, especially in Japanese patients, remains unknown. We reported 15 cases of PCC treatment in the emergency department (ED) in 2015 and found that a fixed PCC dose of 500 IU is insufficient in some patients with INR elevation.…”