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Coagulation Factor Concentrate — Warfarin Reversal Pregnancy: Use only if clearly life-saving

Prothrombin Complex Concentrate (PCC)

Brand names: Beriplex, Octaplex

Adult dose

Dose: 25-50 units/kg IV (weight-based, guided by INR)
Route: Intravenous bolus
Frequency: Single dose; repeat guided by INR
Max: 3000 units per dose (Beriplex)
INR 2-3.9: 25 units/kg. INR 4-6: 35 units/kg. INR above 6: 50 units/kg. Give with vitamin K 5-10 mg IV concurrently. Target INR below 1.5 urgently

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: IV
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • Fastest warfarin reversal available — restores coagulation factors II, VII, IX, X within minutes; vitamin K alone takes 4-6 hours, FFP takes longer and requires large volume
  • Always co-administer vitamin K IV — PCC effect is temporary (6-8 hours); vitamin K resynthesises factors to sustain INR correction
  • Indications: major/life-threatening bleeding on warfarin, emergency surgery in anticoagulated patient, intracranial haemorrhage on warfarin
  • 4-factor PCC (Beriplex, Octaplex) contains factors II, VII, IX, X — superior to 3-factor PCC for warfarin reversal
  • DOAC reversal: idarucizumab for dabigatran, andexanet alfa for rivaroxaban/apixaban — PCC is used off-label for DOAC-related bleeding when specific antidotes unavailable

Contraindications

  • Heparin-induced thrombocytopenia (HIT) — contains heparin in some formulations
  • DIC

Side effects

  • Thromboembolism (VTE, MI, stroke — hypercoagulable state)
  • Hypersensitivity reactions
  • Transmission of blood-borne infection (treated — very low risk)
  • Headache
  • Dizziness

Interactions

  • Warfarin (reversal agent — expected interaction)
  • Anticoagulants (reduce efficacy of reversal)

Monitoring

  • INR (30 minutes post-dose, then 6-8 hourly)
  • Signs of thromboembolism
  • Vital signs during infusion

Reference: BNFc; BNF 90; NICE NG185; BSH Guideline on Anticoagulant Reversal 2022; BCSH Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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