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Prothrombin Complex Concentrates (Octaplex and Beriplex) 💊
🚨 Emergency tip: Always consider urgent Prothrombin Complex Concentrate (PCC) for any intracranial bleed on Warfarin with INR >1.5. 👉 Always give with IV Vitamin K. Seek urgent haematology advice.
📖 About
Always check the BNF link here.
- Common brands: Octaplex, Beriplex.
- 💷 Very expensive; usually requires haematologist authorisation.
⚡ Mechanism of Action
- Rapidly reverses anticoagulant effect of Warfarin (VKA).
- Contains vitamin K–dependent clotting factors II, VII, IX, X.
- Restores thrombin generation → improves haemostasis.
🩺 Indications (expert haematology advice required)
- Life-threatening haemorrhage (e.g. GI bleed, retroperitoneal bleed).
- 🧠 Intracranial haemorrhage (ICH).
- Urgent reversal of Warfarin prior to emergency surgery.
- Some Xa inhibitor–associated bleeds (off-label, with haematology guidance).
💊 Dosing – PCC (Beriplex / Octaplex, always with IV Vitamin K)
| Indication | Details |
|---|---|
| 🩸 Warfarin / VKA Reversal |
PCC
• INR 2–6 → 25 units/kg IV • INR >6 → 50 units/kg IV • Always give with Vitamin K 5 mg IV |
| 🧠 Intracerebral Bleed (Warfarin / Xa inhibitors) |
PCC 50 units/kg IV stat (max 3,000 units)
⚠️ Do not delay for INR result |
| 💉 Administration |
• Slow IV infusion via syringe pump
• Start 1 mL/min → increase to max 3 mL/min as tolerated • Infusion may take ~30 min 🔄 Re-check INR at 6 h and re-dose only on haematology advice |
⚠️ Interactions
- See BNF (caution with other pro-thrombotic drugs).
⚠️ Cautions
- Fridge-stored product (2–8 °C only).
- Use with specialist oversight due to cost + thrombosis risk.
🚫 Contraindications
- Known allergy to Heparin or excipients.
- History of Heparin-induced thrombocytopenia (HIT).
- Pregnancy → specialist discussion required.
💥 Side Effects
- 🤧 Hypersensitivity / allergic reactions.
- 🧬 Development of antibodies to PCC components.
- ⚡ Risk of thrombosis.
- ⬇️ Rare: heparin-associated fall in platelets (HIT-like reaction).
- 🦠 Viral transmission risk (HAV, parvovirus B19) – not always fully deactivated despite screening.
📑 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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