Prothrombin Complex Concentrate (PCC)

How it works

It rapidly replaces coagulation factors II, VII, IX and X (with proteins C and S), immediately restoring thrombin generation that vitamin K antagonists have suppressed.

Prescribing in practice

• Administer intravenous vitamin K at the same time, because the effect of PCC is temporary and vitamin K is needed for sustained correction of the INR.
• It carries a risk of thromboembolism, so use only for genuine indications such as major or life-threatening haemorrhage or urgent surgery, and weigh the thrombotic risk.
• Dosing is typically guided by body weight and the baseline INR according to local major-haemorrhage protocols and the SPC.

Monitoring

Check the INR before and after administration to confirm reversal, and monitor for bleeding control and any signs of thrombosis.

Counselling the patient

• Explain to the patient or family that this product rapidly reverses the effect of blood-thinning medication during serious bleeding.
• Note that vitamin K is given alongside it to keep the reversal durable.
• Inform the team to remain alert for clotting complications afterwards.

Evidence & guidelines

NICE recommends prothrombin complex concentrate with intravenous vitamin K for emergency reversal of vitamin K antagonist anticoagulation in major bleeding.