Prothrombin Complex Concentrate (4-factor)
Warfarin reversal for major bleeding, Urgent surgery in warfarin patients, Factor Xa inhibitor reversal (off-label)
Indications
- Warfarin reversal for major bleeding
- Urgent surgery in warfarin patients
- Factor Xa inhibitor reversal (off-label)
Adult dosing
- inr 2 4: dose: 25; unit: units/kg; route: IV; maxDose: 2500; maxDoseAbsolute: true; weightBased: true; inr 4 6: dose: 35; unit: units/kg; route: IV; maxDose: 3500; maxDoseAbsolute: true; weightBased: true; inr over 6: dose: 50; unit: units/kg; route: IV; maxDose: 5000; maxDoseAbsolute: true; weightBased: true
Pediatric dosing
- contraindicated: true; reason: Limited pediatric data; dosing extrapolated from adult data — consult hematology
Contraindications
- DIC (relative)
- HIT with active thrombosis
Clinical pearls
- Give with Vitamin K 10mg IV for sustained reversal
- INR-based dosing: 2-4 → 25u/kg, 4-6 → 35u/kg, >6 → 50u/kg
- Maximum infusion rate 210 units/min (8.4 mL/min)
- Preferred over FFP — faster, lower volume, more predictable effect
Source and review
- AHA/ASA Guidelines; Neurocrit Care Society 2016. Last reviewed: 2024-11-01