Skip to main content
SpringerLink
Log in

Prothrombin Complex Concentrate: Anticoagulation Reversal and Beyond

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2018

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Grottke O, Rossaint R, Henskens Y, van Oerle R, Ten Cate H, Spronk HM (2013) Thrombin generation capacity of prothrombin complex concentrate in an in vitro dilutional model. PLoS One 8:e64100

    Article  CAS  Google Scholar 

  2. Electronic Medicines Compendium (2017) Beriplex P/N 500 summary of product characteristics. https://www.medicines.org.uk/emc/medicine/20797. Accessed 10 January 2018

    Google Scholar 

  3. Sarode R, Milling TJ Jr, Refaai MA et al (2013) Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation 128:1234–1243

    CAS  PubMed  Google Scholar 

  4. Goldstein JN, Refaai MA, Milling TJ Jr et al (2015) Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet 385:2077–2087

    Article  CAS  Google Scholar 

  5. Hickey M, Gatien M, Taljaard M, Aujnarain A, Giulivi A, Perry JJ (2013) Outcomes of urgent warfarin reversal with frozen plasma versus prothrombin complex concentrate in the emergency department. Circulation 128:360–364

    Article  CAS  Google Scholar 

  6. Tazarourte K, Riou B, Tremey B, Samama CM, Vicaut E, Vigue B (2014) Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study). Crit Care 18:R81

    Article  Google Scholar 

  7. Kozek-Langenecker SA, Ahmed AB, Afshari A et al (2017) Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. Eur J Anaesthesiol 34:332–395

    Article  Google Scholar 

  8. Rossaint R, Bouillon B, Cerny V et al (2016) The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 20:1–55

    Article  Google Scholar 

  9. Grottke O, Aisenberg J, Bernstein RV et al (2016) Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation. Crit Care 20:115

    Article  Google Scholar 

  10. Pollack CV Jr, Reilly PA, van Ryn J et al (2017) Idarucizumab for dabigatran reversal – full cohort analysis. N Engl J Med 377:431–441

    Article  CAS  Google Scholar 

  11. Connolly SJ, Milling TJ Jr, Eikelboom JW et al (2016) Andexanet alfa for acute major bleeding associated with Factor Xa inhibitors. N Engl J Med 375:1131–1141

    Article  CAS  Google Scholar 

  12. Honickel M, Braunschweig T, van Ryn J et al (2015) Prothrombin complex concentrate is effective in treating the anticoagulant effects of dabigatran in a porcine polytrauma model. Anesthesiology 123:1350–1361

    Article  CAS  Google Scholar 

  13. Herzog E, Kaspereit F, Krege W et al (2015) Effective reversal of edoxaban-associated bleeding with four-factor prothrombin complex concentrate in a rabbit model of acute hemorrhage. Anesthesiology 122:387–398

    Article  CAS  Google Scholar 

  14. Herzog E, Kaspereit F, Krege W et al (2015) Four-factor prothrombin complex concentrate reverses apixaban-associated bleeding in a rabbit model of acute hemorrhage. J Thromb Haemost 13:2220–2226

    Article  CAS  Google Scholar 

  15. Brown KS, Wickremasingha P, Parasrampuria DA et al (2015) The impact of a three-factor prothrombin complex concentrate on the anticoagulatory effects of the factor Xa inhibitor edoxaban. Thromb Res 136:825–831

    Article  CAS  Google Scholar 

  16. Zahir H, Brown KS, Vandell AG et al (2015) Edoxaban effects on bleeding following punch biopsy and reversal by a 4-factor prothrombin complex concentrate. Circulation 131:82–90

    Article  CAS  Google Scholar 

  17. Nagalla S, Thomson L, Oppong Y, Bachman B, Chervoneva I, Kraft WK (2016) Reversibility of apixaban anticoagulation with a four-factor prothrombin complex concentrate in healthy volunteers. Clin Transl Sci 9:176–180

    Article  CAS  Google Scholar 

  18. Majeed A, Agren A, Holmstrom M et al (2017) Management of rivaroxaban or apixaban associated major bleeding with prothrombin complex concentrates: a cohort study. Blood 130:1706–1712

    Article  Google Scholar 

  19. Hiippala ST, Myllyla GJ, Vahtera EM (1995) Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates. Anesth Analg 81:360–365

    CAS  PubMed  Google Scholar 

  20. Schöchl H, Voelckel W, Grassetto A, Schlimp CJ (2013) Practical application of point-of-care coagulation testing to guide treatment decisions in trauma. J Trauma Acute Care Surg 74:1587–1598

    Article  Google Scholar 

  21. Schöchl H, Nienaber U, Maegele M et al (2011) Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. Crit Care 15:R83

    Article  Google Scholar 

  22. Innerhofer P, Westermann I, Tauber H et al (2013) The exclusive use of coagulation factor concentrates enables reversal of coagulopathy and decreases transfusion rates in patients with major blunt trauma. Injury 44:209–216

    Article  Google Scholar 

  23. Innerhofer P, Fries D, Mittermayr M et al (2017) Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial. Lancet Haematol 4:e258–e271

    Article  Google Scholar 

  24. Joseph B, Aziz H, Pandit V et al (2014) Prothrombin complex concentrate versus fresh-frozen plasma for reversal of coagulopathy of trauma: is there a difference? World J Surg 38:1875–1881

    Article  Google Scholar 

  25. Joseph B, Khalil M, Harrison C et al (2016) Assessing the efficacy of prothrombin complex concentrate in multiply injured patients with high-energy pelvic and extremity fractures. J Orthop Trauma 30:653–658

    Article  Google Scholar 

  26. Görlinger K, Dirkmann D, Hanke AA et al (2011) First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 115:1179–1191

    PubMed  Google Scholar 

  27. Karkouti K, Callum J, Wijeysundera DN et al (2016) Point-of-care hemostatic testing in cardiac surgery: a stepped-wedge clustered randomized controlled trial. Circulation 134:1152–1162

    Article  Google Scholar 

  28. Weber CF, Gorlinger K, Meininger D et al (2012) Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 117:531–547

    Article  Google Scholar 

  29. Arnekian V, Camous J, Fattal S, Rezaiguia-Delclaux S, Nottin R, Stephan F (2012) Use of prothrombin complex concentrate for excessive bleeding after cardiac surgery. Interact Cardiovasc Thorac Surg 15:382–389

    Article  Google Scholar 

  30. Cappabianca G, Mariscalco G, Biancari F et al (2016) Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery. Crit Care 20:5

    Article  Google Scholar 

  31. Song HK, Tibayan FA, Kahl EA et al (2014) Safety and efficacy of prothrombin complex concentrates for the treatment of coagulopathy after cardiac surgery. J Thorac Cardiovasc Surg 147:1036–1040

    Article  CAS  Google Scholar 

  32. Lorenz R, Kienast J, Otto U et al (2003) Efficacy and safety of a prothrombin complex concentrate with two virus-inactivation steps in patients with severe liver damage. Eur J Gastroenterol Hepatol 15:15–20

    Article  CAS  Google Scholar 

  33. Huang WT, Cang WC, Derry KL, Lane JR, von Drygalski A (2016) Four-factor prothrombin complex concentrate for coagulopathy reversal in patients with liver disease. Clin Appl Thromb Hemost 23:1028–1035

    Article  Google Scholar 

  34. Lesmana CR, Cahyadinata L, Pakasi LS, Lesmana LA (2016) Efficacy of prothrombin complex concentrate treatment in patients with liver coagulopathy who underwent various invasive hepatobiliary and gastrointestinal procedures. Case Rep Gastroenterol 10:315–322

    Article  Google Scholar 

  35. Bruce D, Nokes TJ (2008) Prothrombin complex concentrate (Beriplex P/N) in severe bleeding: Experience in a large tertiary hospital. Crit Care 12:R105

    Article  Google Scholar 

  36. Schick KS, Fertmann JM, Jauch KW, Hoffmann JN (2009) Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding. Crit Care 13:R191

    Article  Google Scholar 

  37. Young H, Holzmacher JL, Amdur R, Gondek S, Sarani B, Schroeder ME (2017) Use of four-factor prothrombin complex concentrate in the reversal of warfarin-induced and nonvitamin K antagonist-related coagulopathy. Blood Coagul Fibrinolysis 28:564–569

    Article  CAS  Google Scholar 

  38. Dusel CH, Grundmann C, Eich S, Seitz R, Konig H (2004) Identification of prothrombin as a major thrombogenic agent in prothrombin complex concentrates. Blood Coagul Fibrinolysis 15:405–411

    Article  CAS  Google Scholar 

  39. Schöchl H, Grottke O, Sutor K et al (2017) Theoretical modelling of coagulation management with therapeutic plasma or prothrombin complex concentrate. Anesth Analg 125:1471–1474

    Article  Google Scholar 

  40. Hanke AA, Joch C, Görlinger K (2013) Long-term safety and efficacy of a pasteurized nanofiltrated prothrombin complex concentrate (Beriplex P/N): a pharmacovigilance study. Br J Anaesth 110:764–772

    Article  CAS  Google Scholar 

  41. Grottke O, Braunschweig T, Spronk HM et al (2011) Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury. Blood 118:1943–1951

    Article  CAS  Google Scholar 

  42. Schöchl H, Voelckel W, Maegele M, Kirchmair L, Schlimp CJ (2014) Endogenous thrombin potential following hemostatic therapy with 4-factor prothrombin complex concentrate: a 7-day observational study of trauma patients. Crit Care 18:R147

    Article  Google Scholar 

  43. Grottke O, Levy JH (2015) Prothrombin complex concentrates in trauma and perioperative bleeding. Anesthesiology 122:923–931

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany

    O. Grottke

  2. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria

    H. Schöchl

  3. Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria

    H. Schöchl

Authors
  1. O. Grottke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Schöchl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Grottke .

Editor information

Editors and Affiliations

  1. Dept. of Intensive Care Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Grottke, O., Schöchl, H. (2018). Prothrombin Complex Concentrate: Anticoagulation Reversal and Beyond. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2018. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-73670-9_34

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-73670-9_34

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-73669-3

  • Online ISBN: 978-3-319-73670-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation