Monday, May 18, 2020

PCC for emergent VKA reversal

emDocs - May 17, 2020 - By Moussavi K and Quyen N 
Reviewed by: Lentz S; Koyfman A and Long B
"Take Home Points
  • Patients with urgent or emergent need for VKA reversal require IV vitamin K 5-10 mg and PCC.
  • PCC dosing approved by manufacturers for VKA reversal may be complicated, result in excessive administration of clotting factors, and be more expensive than other dosing strategies.
  • Fixed-dose PCC refers to giving a predetermined dose (e.g. 1500 units) instead of a variable dose based on weight and pretreatment INR (e.g. 25-50 units/kg for INR 2 to >6).
  • There is currently limited evidence to support fixed-dose strategies; however, some studies suggest doses 1500-2000 units can provide similar efficacy and safety when compared to weight/INR-based regimens.
  • Fixed doses ≤1000 units may be insufficient for VKA reversal, especially in patients with intracranial hemorrhage.
  • If a fixed dose strategy is adopted, consider adding a re-dose option (e.g. if INR goal not achieved, give remainder of weight/INR-based dose per package insert)."