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

Top Questions on...

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:

  • See question # 7


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

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A practical, evidence-based guide for front-line physicians on how to treat acquired bleeding