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just had an anticoagulated pt on xarelto with a large ICH(trauma vs hem. stroke). transfered from my rural job by lifeflight w/ mannitol and nicardipine drips on board, intubated. the hospitalist I spoke with recommended Kcerta as a last ditch option but pt was out of dept before med available. may order sooner next time. anyone have experience with this drug?

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Used it once so far for a big head bleed (of the top of my head I think it was coumadin with a high INR).  I don't recall anything exciting about it other than it was faster to get to the ED than the FFP we usually use.  Does your pharmacy have a guideline on it's use?  If not I've got an institutional protocol for when to use it; let me know if you're interested and I'll send it your way.

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VHS Newsletter, November 2013, page 2

A New 4-Factor Prothrombin Complex Concentrate, Human (PCC); Kcentra®

Recently, a new 4-factor prothrombin complex concentrate (PCC) product (Kcentra®) was approved by the Food and Drug Administration (FDA) for the urgent reversal of acquired coagulation factor deficiency induced by vitamin K antagonist (e.g., warfarin) therapy in adults with acute major bleeding.  


It is not indicated for use in patients without acute major bleeding.  Kcentra (CSL Behring LLC) contains the vitamin K dependent clotting factors II, VII, IX, and X in an activated form.  It also contains the antithrombotic proteins C and S, antithrombin III, and heparin.  Therefore, known heparin-induced thrombocytopenia (HIT) is a contraindication to use Kcentra.  


It is also contraindicated in patients with disseminated intravascular coagulation (DIC).  Kcentra ha

s a black box warning of the risk of arterial and venous thromboembolic complications.  Both fatal and nonfatal arterial and venous thromboembolic have been reported with the use of PCC.  Dosing is stated

in terms of factor IX potency and should be individualized based on the patient's INR and body weight.  

Compared with fresh frozen plasma (FFP), PCC does not require cross-matching, does not cause

volume overload, and can be quickly infused.  



THIS WAS JUST PUT OUT by our HOSP- new to all of us and these are the guidlimes we were given.



In clinical trials, PCC was able to produce a rapid reduction in INR and hemostasis efficacy.  Most common adverse reactions observed in at least 2.8% of patients receiving PCC were headache, nausea/vomiting, arthralgia, and hypotension.

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