title: Limb-threatening Deep Venous Thrombosis Complicating Warfarin Reversal with Three-factor Prothrombin Complex Concentrate: A Case Report.
abstract: BACKGROUND
  Three- and four-factor prothrombin complex concentrates (PCC) are gaining popularity for acute reversal of vitamin K antagonist-associated bleeding. Although acute thrombosis after PCC administration has been described, it seems to be rare.
  
  
  METHODS
  An 83-year-old woman on warfarin for history of deep venous thrombosis (DVT) presented to the Emergency Department with life-threatening gastrointestinal bleeding, requiring urgent PCC administration. After stabilization, she subsequently developed a new limb-threatening upper-extremity DVT. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As PCC therapy gains popularity for reversal of anticoagulant-induced bleeding in urgent bleeding scenarios, the emergency physician must be aware of the complications of PCC administration, including new limb-threatening DVT.
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Jablow
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey; Division of Emergency Medical Services (EMS), Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey.
authors.forename: Gerard G
authors.initials: GG
authors.lastname: Carroll
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey.
authors.forename: Stephanie V
authors.initials: SV
authors.lastname: Wilsey
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey.
authors.forename: Rachel
authors.initials: R
authors.lastname: Haroz
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D034941:Upper Extremity / Q000098:blood supply; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000188:drug therapy; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D005343:Fibrinolytic Agents; C025667:prothrombin complex concentrates; D014859:Warfarin; D006493:Heparin
keywords: deep venous thrombosis; limb-threatening; prothrombin complex concentrate; three-factor; warfarin reversal