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Crit Care. 2011;15(1):201. doi: 10.1186/cc9311. Epub 2011 Jan 12.

Clinical review: Prothrombin complex concentrates--evaluation of safety and thrombogenicity.

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Haemostasis Research Unit, Centre for Haemostasis and Thrombosis, Department of Haematology and Oncology, Guy's and St Thomas' Hospital & NHS Trust Foundation, King's College London School of Medicine, 1st Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.

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  • Crit Care. 2011;15(2):409.


Prothrombin complex concentrates (PCCs) are used mainly for emergency reversal of vitamin K antagonist therapy. Historically, the major drawback with PCCs has been the risk of thrombotic complications. The aims of the present review are to examine thrombotic complications reported with PCCs, and to compare the safety of PCCs with human fresh frozen plasma. The risk of thrombotic complications may be increased by underlying disease, high or frequent PCC dosing, and poorly balanced PCC constituents. The causes of PCC thrombogenicity remain uncertain but accumulating evidence indicates the importance of factor II (prothrombin). With the inclusion of coagulation inhibitors and other manufacturing improvements, today's PCCs may be considered safer than earlier products. PCCs may be considered preferable to fresh frozen plasma for emergency anticoagulant reversal, and this is reflected in the latest British and American guidelines. Care should be taken to avoid excessive substitution with prothrombin, however, and accurate monitoring of patients' coagulation status may allow thrombotic risk to be reduced. The risk of a thrombotic complication due to treatment with PCCs should be weighed against the need for rapid and effective correction of coagulopathy.

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