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