4-factor prothrombin complex concentrate (PCC)

Dried prothrombin complex

Brand names: Beriplex, Octaplex

Adult dose

Dose: Warfarin reversal: 25–50 units/kg IV (per INR); typical 30 units/kg with vitamin K 5mg IV

Route: IV

Frequency: Single dose; repeat per INR

Clinical pearls

BSH guideline: PCC + IV vitamin K for major bleeding on warfarin (preferred over FFP — faster, lower volume)
NICE NG24 transfusion / NG143 stroke
Off-label DOAC reversal — andexanet alfa (FXa) and idarucizumab (dabigatran) are specific antidotes
Time-critical in intracranial haemorrhage on warfarin (target INR <1.4 within 30 min)

Contraindications

DIC
HIT
IgA deficiency with anti-IgA
Hypersensitivity

Side effects

Thromboembolism (arterial and venous)
Allergic / anaphylactoid reactions
Headache
Nausea

Interactions

Heparin (within product)
Antifibrinolytics

Monitoring

INR (15 min and 30 min post-dose)
Bleeding control
Thromboembolic complications

Reference: BNF; BSH warfarin reversal guideline; NICE NG24; NICE NG143; https://bnf.nice.org.uk/drugs/dried-prothrombin-complex/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways