title: Perioperative use of prothrombin complex concentrates.
abstract: Prothrombin complex concentrates (PCCs) are purified drug products with hemostatic activity derived from a plasma pool. Today, PCCs contain a given and proportional amount of four non-activated vitamin K-dependent coagulation factors (II, VII, IX, and X), a variable amount of anticoagulant proteins (proteins C and S, and in some antithrombin) and low-dose heparin. In some countries PCC products contained only three clotting factors, II, IX, and X. Dosage recommendations are based on IU of F-IX, so that one IU of F-IX represents the activity of F-IX in 1 mL of plasma. Reversion of the anticoagulant effect of vitamin K antagonists (VKAs) in cases of symptomatic overdose, active bleeding episodes, or need for emergency surgery is the most important indication for PCCs and this effect of PCCs appears to be more complete and rapid than that caused by administration of fresh frozen plasma. They may be considered as safe preparations if they are used for their approved indications at the recommended dosage with adequate precautions for administration, and have been shown to be effective for reversing the effect of VKAs. Their adequate use based on decision algorithms in the perioperative setting allows a rapid normalization of International Normalized Ratio (INR) for performing emergency surgery, minimizing bleeding risk. This review aims to propose two algorithms for the use of PCCs in the perioperative setting, one to calculate the PCCs dose to be administered in a bleeding patient and/or immediately before urgent surgery, based on patient's clinical status, prior INR and INR target and another for reversing the action of oral anticoagulants depending on urgency of surgery.
authors.affiliation: Department of Anesthesiology, Vall d'Hebron University Hospital, Area of Orthopedic Surgery, Barcelona, Spain. mjcolomina@vhebron.net
authors.forename: M J
authors.initials: MJ
authors.lastname: Colomina
authors.forename: A
authors.initials: A
authors.lastname: Díez Lobo
authors.forename: I
authors.initials: I
authors.lastname: Garutti
authors.forename: A
authors.initials: A
authors.lastname: Gómez-Luque
authors.forename: J V
authors.initials: JV
authors.lastname: Llau
authors.forename: E
authors.initials: E
authors.lastname: Pita
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000009:adverse effects; D000931:Antidotes / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis / Q000737:chemistry / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D016903:Drug Monitoring; D004630:Emergencies; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D017093:Liver Failure / Q000150:complications; D019990:Perioperative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D013923:Thromboembolism / Q000139:chemically induced / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D000931:Antidotes; D001779:Blood Coagulation Factors; D006490:Hemostatics; D014812:Vitamin K; C025667:prothrombin complex concentrates