NICE - indication for prothrombin complex concentrate

Prothrombin complex concentrate

Thresholds and targets

prothrombin complex concentrate transfusions should be immediately offered for the emergency reversal of warfarin anticoagulation in patients with either:

• severe bleeding or
• head injury with suspected intracerebral haemorrhage.

Reversal of anticoagulation treatment in people with haemorrhagic stroke

• clotting levels in people with a primary intracerebral haemorrhage who were receiving anticoagulation treatment before their stroke (and have elevated INR) should be returned to normal as soon as possible, by reversing the effects of the anticoagulation treatment using a combination of prothrombin complex concentrate and intravenous vitamin K.

Consider immediate prothrombin complex concentrate transfusions to reverse warfarin anticoagulation in patients having emergency surgery, depending on the level of anticoagulation and the bleeding risk.

If used prothrombin complex concentrate then

• monitor the international normalised ratio (INR) to confirm that warfarin anticoagulation has been adequately reversed, and consider further prothrombin complex concentrate

Reference:

• NICE (November 2015). Blood transfusion