Danny Liang, MD
Prothrombin Complex Concentrate (PCC) is superior to Fresh Frozen Plasma (FFP) and Vitamin K for INR reversal. PCCs should be the initial reversal agents for Warfarin. FFP and Vitamin K should be relegated as adjuncts for reversal. PCCs are currently reserved for patients with emergent intracranial hemorrhages requiring surgery. Non emergent brain hemorrhages frequently convert into emergencies while observing the patient. Better prevention of expansions and subsequent unplanned emergency surgery is achieved with PCC as the first line reversal agent for all intracranial hemorrhages in patients on Warfarin, rather than only those that are deemed to be emergent/requiring surgery. Through this intervention, more complete INR reversal to less than 1.3 after single agent administration is achieved. Patients who suffer brain bleeds are better protected from delayed expansion of intracranial hemorrhages, resulting in decreased incidence of unplanned surgery during the hospital stay and decreased LOS associated with better long-term functional status.
Lanehart S. First-Line Administration of Prothrombin Complex Concentrate to Prevent Expansion of All Size Intracranial Hemorrhage. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2021; 3(2).
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