Greetings,

I read an article in the Nov/Dec. issue of AABB News about transfusion issues with older people. One of the things it highlighted was the risk of TACO with plasma transfusion for warfarin reversal. It suggested the use of Prothrombin complex concentrates (PCC's) for this purpose. I started looking into this and found a not-so-favorable article on the use of PCC's in a May 2012 article in Transfusion.

Is anyone using PCC's at their hospital? If so, what are the guidelines?

Thanks,

Amelia

We are only using them for reversal of INR for those folks taking the thrombin inhibitors.

PCC is recommended rather than FFP for warfarin reversal in the UK (in the absence of contra-indications). Having issued it for that purpose for many years iny experience it had the advantages of ease of storage, ease of issue, plus speedy and reliable action. The disadvantages were expense and disagreement between doctors and nurses on the ward about who should reconstitute and give the stuff (which is more labour intensive and time consuming for them, apparently, than 'slinging' up FFP) which could lead to long delays in its administration. Much of this was, I think, due to them often not having seen it before and being frightened - certainly an intensive education processs and rewriting the instructions in VERY simple language went a long way to solving this. We had a simple dosage policy dependent on INR (above or below 3.5) and the patient's weight which allowed even our overnight non-transfusion staff to issue the correct amount after referring to the graph on the outside of the refrigerator we stored it in.

Greetings,

I read an article in the Nov/Dec. issue of AABB News about transfusion issues with older people. One of the things it highlighted was the risk of TACO with plasma transfusion for warfarin reversal. It suggested the use of Prothrombin complex concentrates (PCC's) for this purpose. I started looking into this and found a not-so-favorable article on the use of PCC's in a May 2012 article in Transfusion.

Is anyone using PCC's at their hospital? If so, what are the guidelines?

Thanks,

Amelia

What is the title of the article? I'm interested in reading it but didn't see it in the May 2012 issue. Thank you!

Looking closer, the article is 'Reversal of drug-induced anticoagulation: old solutions and new problems' in an issue supplement, Volume 52, S1, pages 45S-55S, May 2012.

Thank you pstruik for you input. I found that PCC's have 2 formulations, 3 factor and 4 factor. It seems that, while more effective, the 4 factor is not available in the US. This may explain why so few people know about it's use. I'm still pursuing this issue.

Amelia,

I'm sure you've read page 590 in the AABB TM, ed 17? It states that PCCs in the US need to be given with FFP because of the low level of FVII.

Why do you suppose PCC in the US has little factor VII? Is it a safety issue, a manufacturing issue, or an economic issue?

Catherine

PCCs are costly, so our hospital does not want to use them routinely for coumadin reversal.

We routinely use PCCs for warfarin reversal. It really works fast to bring down the INR. The cost (here in Canada) is not a lot more than FP. It reduces risk of TACO and compliance is better (ie we used to see a lot of docs ordering 4 units of FP but often they would not all get transfused).

We follow the NAC (National Advisory Council on Blood and Blood Products) guidelines for dosing. Although, it is probably better to use the manufacturers recommendations for dosing as it also takes into account patient weight.