Dried prothrombin complex

How it works

It rapidly replaces clotting factors II, VII, IX and X, restoring thrombin generation and the coagulation cascade.

Prescribing in practice

• Carries a risk of thromboembolic complications including disseminated intravascular coagulation, so it should be reserved for clear indications and given with careful clinical assessment.
• When used to reverse a vitamin K antagonist, concurrent intravenous vitamin K is usually required because the effect of the concentrate is temporary.
• Being plasma-derived, it carries a theoretical risk of transmissible infection despite manufacturing safety steps, and the brand and batch should be recorded.

Monitoring

Monitor coagulation parameters such as the INR and clinical signs of bleeding or thrombosis before and after administration.

Counselling the patient

• Tell the team about any history of clots, heart disease or previous reactions to blood products.
• Report symptoms of a clot, such as leg swelling, chest pain or breathlessness, promptly.

Evidence & guidelines

Prothrombin complex concentrate is recommended for emergency reversal of vitamin K antagonists in major bleeding by NICE and haematology guidelines.