From the Guidelines
Kcentra (Prothrombin Complex Concentrate) should be administered at a dose of 25 units/kg for INR 2 to <4,35 units/kg for INR 4 to 6, and 50 units/kg for INR >6, with a maximum dose of 5,000 units, for urgent reversal of anticoagulation in patients taking warfarin with bleeding or requiring urgent surgery. The dosing is based on the patient's pre-treatment INR and body weight, as recommended by the 2020 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants 1. Kcentra should be administered intravenously at a rate not exceeding 8.4 mL/minute (approximately 210 units/minute).
- Key considerations for Kcentra administration include:
- Concurrent administration of vitamin K (10 mg by slow IV infusion) to maintain coagulation factor levels once the effects of Kcentra diminish
- Onset of action is rapid, typically within 10-30 minutes
- INR should be checked after administration, and if inadequate, additional dosing may be considered
- Kcentra works by immediately replacing the vitamin K-dependent clotting factors (II, VII, IX, and X) that are inhibited by warfarin, allowing for rapid hemostasis in emergency situations
- This approach is preferred over fresh frozen plasma for urgent reversal due to its faster administration, smaller volume, and more complete factor replacement, as noted in the 2020 ACC expert consensus decision pathway 1.
From the Research
Kcentra (Prothrombin Complex Concentrate) for Urgent Reversal of Anticoagulation
- Kcentra is a prothrombin complex concentrate (PCC) used for the urgent reversal of anticoagulation in patients taking warfarin with bleeding or requiring urgent surgery 2, 3.
- The recommended dose of Kcentra for urgent reversal of anticoagulation is not explicitly stated in the provided studies, but a fixed-dose of 2000 units of 4PCC has been shown to be effective in achieving a target INR ≤ 1.4 2.
- Administration of Kcentra should be done concurrently with intravenous vitamin K1 to ensure sustained reversal of anticoagulation 4.
- The use of Kcentra has been shown to result in faster reversal of anticoagulation and lower red cell transfusion requirements compared to frozen plasma 3.
Comparison with Other Reversal Agents
- Kcentra has been compared to frozen plasma and other reversal agents, such as recombinant coagulation factor VIIa, in terms of efficacy and safety 5, 3.
- The choice of reversal agent depends on the urgency of the situation, the patient's condition, and the availability of the agent 4, 3.
Safety and Efficacy
- The safety and efficacy of Kcentra have been demonstrated in several studies, with a lower incidence of serious adverse events compared to frozen plasma 3.
- However, the use of Kcentra is not without risks, and patients should be closely monitored for signs of thromboembolism and other adverse events 4, 3.