Vitamin K antagonists, such as warfarin, are the most commonly prescribed anticoagulant in the United States. Supratherapeutic international normalized ratio (INR) and bleeding are common adverse events and require reversal of the vitamin K antagonist. In a randomized trial, 4-factor prothrombin complex concentrate (PCC) that contains factors II, VII, IX, and X was compared to plasma among 202 patients with major bleeding who required rapid reversal of vitamin K antagonist. The trial demonstrated that 4-factor PCC rapidly normalized the INR, increased coagulation factors, and achieved effective hemostasis either equivalent to or better than plasma. Four-factor PCC has recently been approved by the United States Food and Drug Administration (FDA), and may be used as an alternative to plasma.
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