Prothrombin complex concentrate

Prothrombin complex concentrate
4 factor PCC
Combination of
Factor IIBlood clotting factor
Factor VIIBlood clotting factor
Factor IXBlood clotting factor
Factor XBlood clotting factor
Names
Trade namesBeriplex, Octaplex, Kcentra, others
Other namesfactor IX complex
Clinical data
Main usesHemophilia B, bleeding on warfarin[1][2]
Side effectsAllergic reactions, headache, vomiting, sleepiness[1][3]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Routes of
use		injection
Defined daily dosenot established[4]
External links
AHFS/Drugs.comMonograph
Legal
Legal status
  • US: ℞-only
  • In general: ℞ (Prescription only)

Prothrombin complex concentrate (PCC), also known as factor IX complex, is a medication made up of blood clotting factors II, IX, and X.[1] Some versions also contain factor VII.[5] It is used to treat and prevent bleeding in hemophilia B if pure factor IX is not available.[1][2] It may also be used in those with not enough of these factors due to other reasons such as warfarin therapy.[2] It is given by slow injection into a vein.[1]

Common side effects include allergic reactions, headache, vomiting, and sleepiness.[1][3] Other serious side effects include blood clots which may result in a heart attack, stroke, pulmonary embolism, or deep vein thrombosis.[3] Antibodies may form after long term use such that future doses are less effective.[2]

Prothrombin complex concentrate came into medical use in the 1960s.[6] It is on the World Health Organization's List of Essential Medicines as an alternative to factor IX.[7] It is made from human plasma.[3] A version that is made by recombinant methods which only contains factor IX is also available.[8] In the United States a dose of PCC costs about US$900.[9] A number of different formulations are available globally.[10]

Medical uses

Prothrombin complex concentrate reverses the effects of warfarin and other vitamin K antagonist anti-coagulants and is used in cases of significant bleeding in people with a coagulopathy. It is also used when such a person must undergo an emergency operation treatment.[11] Other uses include a deficiency of one of the included clotting factors, either congenital or due to liver disease, and hemophilia.[11] Several guidelines, including those from the American College of Chest Physicians, recommend prothrombin complex concentrate for warfarin reversal in people with serious bleeding.[12][13][14][15]

For rapid anticoagulation reversal for surgery, four-factor prothrombin complex concentrate reduces international normalized ratio (INR) decreases bleeding during surgery appears better than fresh frozen plasma. No differences in thromboembolic event was found.[16]

Dosage

The defined daily dose is not established.[4]

Contraindications

Platelet factor 4 can cause heparin-induced thrombocytopenia.

The package insert states that prothrombin complex concentrate is contraindicated in patients with disseminated intravascular coagulation, a pathological activation of coagulation,[17] because giving clotting factors would only further fuel this process. However, if the PCC is given because factor levels are low, it can restore normal coagulation. As PCC products contain heparin, they are contraindicated in patients with heparin-induced thrombocytopenia.[17]

Chemistry

Prothrombin complex concentrate contains a number of blood clotting factors. Typically this includes factor II, IX, and X.[1] Some versions also contain factor VII, protein C, and protein S.[5][17] Heparin may be added to stop early activation of the factors.[5]

History

The U.S. Food and Drug Administration (FDA) announced its approval in 2013. The FDA approved Kcentra's orphan drug status in December 2012.[18]

References

  1. 1 2 3 4 5 6 7 World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. pp. 259–60. hdl:10665/44053. ISBN 9789241547659.
  2. 1 2 3 4 British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 171. ISBN 9780857111562.
  3. 1 2 3 4 "Factor IX (Human), Factor IX Complex (Human)". The American Society of Health-System Pharmacists. Archived from the original on 24 September 2017. Retrieved 8 December 2016.
  4. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 26 February 2021. Retrieved 14 September 2020.
  5. 1 2 3 Perkins, John C. (2014). Hematology/Oncology Emergencies, An Issue of Emergency Medicine Clinics of North America. Elsevier Health Sciences. p. 720. ISBN 9780323320290. Archived from the original on 2017-01-05.
  6. ↑ Besa, Emmanuel C. (1992). Hematology. Lippincott Williams & Wilkins. p. 276. ISBN 9780683062229. Archived from the original on 2017-01-09.
  7. ↑ World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
  8. ↑ "Factor IX (Recombinant)". The American Society of Health-System Pharmacists. Archived from the original on 24 September 2017. Retrieved 8 December 2016.
  9. ↑ Murray, Michael J.; Rose, Steven H.; Wedel, Denise J.; Wass, C. Thomas; Harrison, Barry A.; Mueller, Jeff T. (2014). Faust's Anesthesiology Review: Expert Consult (4th ed.). Elsevier Health Sciences. p. 543. ISBN 9781437703672. Archived from the original on 2017-01-09.
  10. ↑ Miller, Ronald D.; Eriksson, Lars I.; Fleisher, Lee A.; Wiener-Kronish, Jeanine P.; Cohen, Neal H.; Young, William L. (2014). Miller's Anesthesia (8 ed.). Elsevier Health Sciences. p. 1892. ISBN 9780323280112. Archived from the original on 2017-01-09.
  11. 1 2 Haberfeld, H, ed. (2015). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Cofact.{{cite book}}: CS1 maint: unrecognized language (link)
  12. ↑ "ACCP 2012 guidelines: 'Evidence-Based Management of Anticoagulant Therapy, Section 9.3 Treatment of Anticoagulant-Related Bleeding'". Chest Journal. Archived from the original on 2013-07-03.
  13. ↑ Haemostasis and Thrombosis Task Force for the British Committee for Standards in Haematology. Guidelines on oral anticoagulation: 3rd edition. Br J Haematol. 1998;101:374-387.
  14. ↑ Baker RI, Coughlin PB, Gallus AS, Harper PL, Salem HH, Wood EM (November 2004). "Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis". The Medical Journal of Australia. 181 (9): 492–7. PMID 15516194.
  15. ↑ Palareti G (1998). "A guide to oral anticoagulant therapy. Italian Federation of Anticoagulation Clinics". Haemostasis. 28 Suppl 1: 1–46. doi:10.1159/000054103. PMID 9820837.
  16. ↑ Levy JH, Douketis J, Steiner T, Goldstein JN, Milling TJ (December 2018). "Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non-vitamin K Anticoagulant Reversal". Anesthesiology. 129 (6): 1171–1184. doi:10.1097/ALN.0000000000002399. PMC 6234087. PMID 30157037.
  17. 1 2 3 "Kcentra- prothrombin, coagulation factor vii human, coagulation factor ix human, coagulation factor x human, protein c, protein s human, and water kit". DailyMed. 22 October 2018. Archived from the original on 25 March 2021. Retrieved 21 April 2020.
  18. ↑ "Kcentra, from CSL Behring, Receives FDA Approval for Use in Warfarin Reversal in Patients Undergoing Surgery". CSL Behring. 13 December 2013. Archived from the original on 6 October 2016. Retrieved 5 October 2016.

Further reading

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