title: Role of prothrombin complex concentrate in perioperative coagulation therapy.
abstract: Prothrombin complex concentrate (PCC) is a term to describe pharmacological products that contain lyophilized, human plasma-derived vitamin K-dependent factors (F), FII, FVII, FIX, FX, and various amounts of proteins C and S. PCCs can be rapidly reconstituted in a small volume (20 ml for about 500 international units (IU)) at bedside and administered regardless of the patient's blood type. PCCs are categorized as 4-factor PCC if they contain therapeutic amounts of FVII, and 3-factor PCC when FVII content is low. In addition, activated PCC which contains activated FVII and FX with prothrombin is available for factor VIII bypassing therapy in hemophilia patients with inhibitors. Currently, 4-factor PCC is approved for the management of bleeding in patients taking warfarin, but there has been increasing use of various PCCs in the treatment of acquired perioperative coagulopathy unrelated to warfarin therapy and in the management of bleeding due to novel oral anticoagulants. There is also an ongoing controversy about plasma transfusion and its potential hazards including transfusion-related lung injury (TRALI). Early fixed ratio plasma transfusion has been implemented in many trauma centers in the USA, whereas fibrinogen concentrate and PCC are preferred over plasma transfusion in some European centers. In this review, the rationales for including PCCs in the perioperative hemostatic management will be discussed in conjunction with plasma transfusion.
authors.affiliation: Department of Anesthesiology, Cardiothoracic Anesthesia Division, University of Maryland, Suite S8D12, 22 South Greene Street, Baltimore, MD 21201 USA.
authors.forename: Kenichi A
authors.initials: KA
authors.lastname: Tanaka
authors.affiliation: Department of Anesthesiology, Cardiothoracic Anesthesia Division, University of Maryland, Suite S8D12, 22 South Greene Street, Baltimore, MD 21201 USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mazzeffi
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Durila
keywords: Coagulation; Factor eight bypassing agent; Fresh frozen plasma; Prothrombin complex concentrate; Recombinant activated factor VII; Thromboelastometry