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Prothrombin complex concentrates: a brief review

Published online by Cambridge University Press:  01 October 2008

C. M. Samama
C. M. Samama*
Affiliation:
Hotel-Dieu University Hospital, Department of Anaesthesiology and Intensive Care, Paris Cedex, France
*
Correspondence to: Charles Marc Samama, Department of Anaesthesiology and Intensive Care, Hotel-Dieu University Hospital, 1, Place du Parvis de Notre-Dame, 75181 Paris Cedex 04, France. E-mail: [email protected]; Tel: +33 1 42 34 85 51; Fax: +33 1 42 34 89 60
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Summary

Prothrombin complex concentrates are haemostatic blood products containing four vitamin K-dependent clotting factors (II, VII, IX and X). They are a useful, reliable and fast alternative to fresh frozen plasma for the reversal of the effects of oral anticoagulant treatments (vitamin K antagonists). They are sometimes used for factor II or factor X replacement in patients with congenital or acquired deficiencies. They are widely prescribed in Europe. Several retrospective and prospective studies have demonstrated their efficacy in normalizing coagulation and in helping to control life-threatening bleeding. Few side-effects, mainly thromboembolic events, have been reported. The link between these events and prothrombin complex concentrate infusion has, however, often been brought into question. The use of prothrombin complex concentrates in new promising indications such as the management of massive bleeding requires prospective studies providing a high level of evidence in a high-risk setting.

Keywords

PROTHROMBIN COMPLEX CONTENTRATESVITAMIN KHAEMORRHAGEDISSEMINATED INTRAVASCULAR COAGULATIONBLEEDINGTHROMBOSISFACTOR IX
Type
Review
Information
European Journal of Anaesthesiology , Volume 25 , Issue 10 , October 2008 , pp. 784 - 789
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Hellstern, P, Halbmayer, WM, Kohler, M et al. Prothrombin complex concentrates: indications, contraindications, and risks: a task force summary. Thromb Res 1999; 95: S3–S6.CrossRefGoogle ScholarPubMed
2.Blauhut, B. Indications for prothrombin complex concentrates in massive transfusions. Thromb Res 1999; 95: S63–S69.CrossRefGoogle ScholarPubMed
3.Hellstern, P. Production and composition of prothrombin complex concentrates: correlation between composition and therapeutic efficiency. Thromb Res 1999; 95: S7–S12.CrossRefGoogle ScholarPubMed
4.Schulman, S, Bijsterveld, NR. Anticoagulants and their reversal. Transfusion Medicine Reviews 2007; 21: 37–48.CrossRefGoogle ScholarPubMed
5.Ansell, J, Hirsh, J, Poller, L et al. The Pharmacology and Management of the Vitamin K Antagonists. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 204–233.CrossRefGoogle ScholarPubMed
6.Ostermann, H, Haertel, S, Knaub, S, Kalina, U, Jung, K, Pabinger, I. Pharmacokinetics of Beriplex P/N prothrombin complex concentrate in healthy volunteers. Thromb Haemost 2007; 98: 790–797.Google Scholar
7.Fredriksson, K, Norrving, B, Strömblad, LG. Emergency reversal of anticoagulation after intracerebral hemorrhage. Stroke 1992; 23: 972–977.CrossRefGoogle ScholarPubMed
8.Cartmill, M, Dolan, G, Byrne, JL, Byrne, PO. Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergencies. British Journal of Neurosurgery 2000; 14: 458–461.CrossRefGoogle ScholarPubMed
9.Makris, M, Greaves, M, Phillips, WS, Kitchen, S, Rosendaal, FR, Preston, EF. Emergency oral anticoagulant reversal: the relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy. Thromb Haemost 1997; 77: 477–480.Google Scholar
10.Makris, M, Watson, HG. The management of coumarin-induced over-anticoagulation Annotation. Br J Haematol 2001; 114: 271–280.CrossRefGoogle ScholarPubMed
11.Lankiewicz, MW, Hays, J, Friedman, KD, Tinkoff, G, Blatt, PM. Urgent reversal of warfarin with prothrombin complex concentrate. J Thromb Haemost 2006; 4: 967–970.CrossRefGoogle ScholarPubMed
12.Baglin, T. Recommendations from the British Committee for Standards in Haematology and National Patient Safety Agency. British Journal of Haematology 2007; 136: 26–29.CrossRefGoogle ScholarPubMed
13.Spannagl, M, Schramm, W. Replacement of coagulation factors in liver or multiple organ dysfunction. Thromb Res 1999; 95: S51–S56.CrossRefGoogle ScholarPubMed
14.Pindur, G, Morsdorf, S. The use of prothrombin complex concentrates in the treatment of hemorrhages induced by oral anticoagulation. Thromb Res 1999; 95: S57–S61.CrossRefGoogle ScholarPubMed
15.van Aart, L, Eijkhout, HW, Kamphuis, JS et al. Individualized dosing regimen for prothrombin complex concentrate more effective than standard treatment in the reversal of oral anticoagulant therapy: an open, prospective randomized controlled trial. Thromb Res 2006; 118: 313–320.CrossRefGoogle ScholarPubMed
16.Yasaka, M, Sakata, T, Naritomi, H, Minematsu, K. Optimal dose of prothrombin complex concentrate for acute reversal of oral anticoagulation. Thromb Res 2005; 115: 455–459.Google Scholar
17.Vigué, B, Ract, C, Tremey, B et al. Ultra-rapid management of oral anticoagulant therapy-related surgical intracranial hemorrhage. Intensive Care Medicine 2007; 33: 721–725.CrossRefGoogle ScholarPubMed
18.Aguilar, MI, Hart, RG, Kase, CS et al. Treatment of warfarin-associated intracerebral hemorrhage: Literature review and expert opinion. Mayo Clin Proc 2007; 82: 82–92.Google Scholar
19.Evans, G, Luddington, R, Baglin, T. Beriplex P/N reverses severe warfarin-induced overanticoagulation immediately and completely in patients presenting with major bleeding. British Journal of Haematology 2001; 115: 998–1001.CrossRefGoogle ScholarPubMed
20.Pabinger, I, Brenner, B, Kalina, U et al. Prothrombin complex concentrate (Beriplex((R)) P/N) for emergency anticoagulation reversal: a prospective multinational clinical trial. J Thromb Haemost 2008; 6: 622–631.Google Scholar
21.Kohler, M, Hellstern, P, Lechler, E et al. Thromboembolic complications associated with the use of prothrombin complex and factor IX concentrates. Thromb Haemost 1998; 80: 399–402.Google ScholarPubMed
22.Kohler, M. Thrombogenicity of prothrombin complex concentrates. Thromb Res 1999; 95: S13–S17.CrossRefGoogle ScholarPubMed
23.Dusel, CH, Grundmann, C, Eich, S, Seitz, R, König, H. Identification of prothrombin as a major thrombogenic agent in prothrombin complex concentrates. Blood Coagul Fibrinolysis 2004; 15: 405–411.Google Scholar
24.Hellstern, P, Beeck, H, Fellhauer, A, Fischer, A, Faller-Stöckl, B. Factor VII and activated-factor-VII content of prothrombin complex concentrates. The PCC Study Group. Vox Sang 1997; 73: 155–161.Google ScholarPubMed
25.Bagot, CN, Cregg, R, Patel, RK, Shariff, A, Arya, R. Perioperative myocardial infarction in a patient receiving low-dose prothrombin complex concentrates. Thromb Haemost 2007; 98: 1141–1142.CrossRefGoogle Scholar
26.Gray, E, Tubbs, J, Thomas, S et al. Measurement of activated factor IX in factor IX concentrates: correlation with in vivo thrombogenicity. Thromb Haemost 1995; 73: 675–679.Google Scholar
27.Riess, HB, Meier-Hellmann, A, Motsch, J, Elias, M, Kursten, FW, Dempfle, CE. Prothrombin complex concentrate (Octaplex((R))) in patients requiring immediate reversal of oral anticoagulation. Thromb Res 2007; 121: 9–16.Google Scholar
28.Van Veen, SQ, Strengers, PF. Use of prothrombin complex concentrates in anticoagulation. Am J Hematol 2008; 83: 344–345.CrossRefGoogle ScholarPubMed
29.Leissinger, CA, Blatt, PM, Hoots, WK, Ewenstein, B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: A review of the literature. Am J Hematol 2008; 83: 137–143.CrossRefGoogle ScholarPubMed