What are the considerations for giving PCC before an urgent surgery / procedure?
The general considerations for giving PCC for warfarin reversal include:
Consider the urgency of the procedure and the risk of bleeding:
- Procedures that are elective should be reversed with vitamin K alone. A meta-analysis demonstrates that ~75% of all patients treated with oral vitamin K reach target INRs at 24 hours post-administration. Vitamin K given IV works within 4-8 hours.
- PCCs must be given within 6 hours of the urgent procedure. Practically, it's best to order it to be given directly pre-operatively (along with antibiotics, factors, etc.) due to its fast onset of action and short duration of effect (6 hours) unless pre-operative bleeding
Potential contraindications to PCCs:
DeZee KJ, Shimeall WT, Douglas KM, Shumway NM, O’Malley PG. Treatment of Excessive Anticoagulation With Phytonadione (Vitamin K): A Meta-analysis. Arch Intern Med. 2006;166(4):391–397.
Spyropoulos, AC, Al‐Badri, A, Sherwood, MW, Douketis, JD. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost 2016; 14: 875– 85.
Hunt BJ, Levi M. Urgent reversal of vitamin K antagonists. BMJ 2018; 360 :j5424