Always consider urgent Prothrombin Complex Concentrate (PCC) and seek advice with any intracranial bleed on Warfarin with an INR > 1.5. Always Give IV Vitamin K as well.
- Octaplex and Beriplex
- Very expensive - access usually through haematologist on call
- For rapid reversal of Warfarin effect
- Contains Factors II,VII,IX,X
Indications: take expert haematological advice
- Life threatening haemorrhage, Gastrointestinal haemorrhage
- Intracranial haemorrhage, Retroperitoneal haemorrhage
- On Warfarin needing urgent surgery
- Warfarin or any VKA antagonist reversal: life-threatening active bleeding: give with Vitamin K 5 mg IV. INR 2-6: give PCC 25 units/kg. INR >6: give PCC 50 units/kg IV.
- Intracerebral bleed on Warfarin, Xa inhibitors: PCC 50 units/kg stat don't wait for INR. (Max dose of 3000 units.)
- PCC given by slow IV infusion with a syringe pump. Start at 1 ml/min, increasing to max of 3 ml/min as tolerated. May take 30 min. Repeat INR again at 6 h.
- It is a fridge only product.
- Allergy to Heparin, History of Heparin-induced thrombocytopenia.
- Pregnancy (Discuss with haem)
- Hypersensitivity or allergic reactions.
- Development of antibodies to one or more of the prothrombin complex constituents.
- Risk of thrombosis.
- Rare cases of development of Heparin-associated fall in platelet count.
- HAV or parvovirus B19 infections which may not be deactivated