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The Effect Of Vitamin K And Fresh Frozen Plasma ( Ffp )

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Due to an increased use of vitamin K antagonists (VKA) and its associated complications, anesthesia providers need to become familiar and comfortable with reversal agents. Currently, a combination of vitamin K and fresh frozen plasma (FFP) in many instituations are still the treatment of choice for reversal of these medications; however, this method is less than ideal because of the slow onset of effects, as well as the volume infused during administration. Prothrombin Complex Concentrate (PCC) offers a rapid reversal in a very small volume of fluid and is currently recommended for treatment of life threatening bleeding from VKAs.1 This literature review will highlight what PCC is, as well as when and how it should be used. Introduction…show more content…
Discussion Although vitamin K along with FFP administration (often 15mL/kg), is currently considered the standard of care for reversal of VKAs, PCC offers an advantageous alternative. PCC is a derivative of fresh frozen plasma (FFP) that contains concentrated inactivated factors II, VII, IX, X, protein C and protein S. Clinically, there are two types of PCC available: three factor (3F-PCC) and four factor (4F-PCC), which are classified by the amount of factor VII the product contains.1 Every brand of PCC contains different concentrations of each clotting factor and antithrombotic components. For example one brand, Octaplex, contains; FII 11-38IU/ml, FVII 9-24IU/kg, FIX 25 IU/ml, FX 18-30IU/kg, protein C 7-31IU/ml, protein S 7-32IU/ml.5 Patients requiring reversal of VKA often present with increased INR and subsequent hemorrhage. Researchers have identified several patient characteristics that increase the risk of refractory bleeding including intensity of anticoagulation, age, hypertension, cerebrovascular disease, ischemic stroke, heart disease, diabetes, renal insufficiency, alcoholism, liver disease and malignancy.8 Overdose for VKAs frequently occurs as a result of inappropriate dosing, changes in protein binding, decrease in vitamin K intake, reduced synthesis/increased clearance of vitamin K factors, and use of other medications. Many
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