Prothrombin Complex Concentrate
Better known as “PCC,” this is a purified, sterilized concentrate of the vitamin K-dependent coagulation factors II, VII, IX, and X. It is very important to recognize that all PCCs are equal! Until 2013, only two forms were approved in the U.S., (Bebulin VH and Profilnine SD). Both contain only very small amounts of factor VII, and as a result, they are really “three-factor” PCCs (or perhaps better termed “Factor IX Complex”). In 2013, the FDA approved “Kcentra” (known as “Beriplex” and “Octaplex” outside of the U.S.), a true “four-factor” PCC with therapeutic FVII concentrations. Current PCC is not “activated” with forms of the factors that bypass factor VIII, taking away much (but not all) of the thrombosis risk associated with previous versions.
Current recommendations for emergency reversal of warfarin anticoagulation often include the use of PCC, but you should understand that this recommendation is really only for four-factor PCC. Three-factor PCCs are actually approved for use only in bleeding patients with hemophilia B (factor IX deficiency), and they may not work well at all without supplemental plasma administration.
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