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EDUCATION IN THE MANAGEMENT OF BLEEDING

A practical, evidence-based guide for front-line physicians on how to Treat the Bleed

Why should I choose PCCs over plasma for warfarin reversal?

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There are several reasons to choose PCCs over frozen plasma including:

  1. Faster correction of the coagulation impairment, particularly pertinent with intracranial bleeding.1,2
  2. Lower volume for infusion (40 mL vs 1000 mL) allowing for faster infusion and more rapid correction of INR
  3. Lower risk of transfusion reactions, particularly respiratory transfusion reactions (transfusion-associated circulatory overload and transfusion-related acute lung injury) 3
  4. No need for blood group testing
  5. There is no increase in the risk of thromboembolic complications compared to plasma.4
  6. Viral inactivation mitigating risk of transfusion-transmissible infections including emerging pathogens.
  7. Use of PCC specifically only replaces the missing coagulation factors missing due to warfarin.

References:

  1. Steiner T, Poli S, Griebe M, et al. Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial. Lancet Neurol 2016;15:566-73.
  2. Frontera JA, Gordon E, Zach V, et al. Reversal of coagulopathy using prothrombin complex concentrates is associated with improved outcome compared to fresh frozen plasma in warfarin-associated intracranial hemorrhage. Neurocrit Care 2014;21:397-406.
  3. Chai-Adisaksopha C, Hillis C, Siegal DM, et al. Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal. A systematic review and meta-analysis. Thromb Haemost 2016;116:879-90.
  4. Brekelmans MPA, Ginkel KV, Daams JG, Hutten BA, Middeldorp S, Coppens M. Benefits and harms of 4-factor prothrombin complex concentrate for reversal of vitamin K antagonist associated bleeding: a systematic review and meta-analysis. J Thromb Thrombolysis 2017;44:118-29.
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A practical, evidence-based guide for front-line physicians on how to treat acquired bleeding