Does Kcentra (4-factor prothrombin complex concentrate) absorb if it is infiltrated?

Kcentra (4-Factor PCC) Infiltration Absorption

Kcentra does not absorb if infiltrated into subcutaneous tissue, as it is designed for intravenous administration only. 1

Mechanism and Administration Considerations

Kcentra (4-factor prothrombin complex concentrate) is a blood product containing concentrated coagulation factors II, VII, IX, and X. It is specifically formulated for intravenous administration and requires proper vascular access for effective delivery to the circulation.

Key points about infiltration:

• Kcentra is a large molecular weight protein complex that does not have properties allowing for absorption through subcutaneous tissue
• The product is designed to deliver coagulation factors directly into the bloodstream
• When infiltrated, the product remains localized in the tissue without significant systemic absorption

Clinical Implications of Infiltration

If infiltration occurs during Kcentra administration:

1. Immediate actions required:

   • Stop the infusion immediately
   • Assess the site for swelling, pain, and extravasation
   • Document the approximate volume infiltrated
   • Consider a new access site for administration of the remaining dose

2. Potential local complications:

   • Local tissue inflammation
   • Pain at infiltration site
   • Potential tissue damage due to volume effect
   • Risk of local thrombosis due to concentrated coagulation factors

Management of Infiltration

If Kcentra infiltrates:

• Apply cold compresses to the affected area to reduce swelling
• Elevate the extremity if possible
• Monitor the site for signs of compartment syndrome or tissue necrosis
• Consider marking the borders of the infiltration to monitor for expansion
• Restart administration at a new site with careful monitoring

Prevention of Infiltration

To prevent infiltration:

• Ensure secure intravenous access before administration
• Use a large-bore peripheral IV or central venous access when possible
• Administer at the recommended rate according to package instructions
• Monitor the IV site continuously during administration
• Consider using an infusion pump with infiltration detection capabilities for high-risk patients

Clinical Context

Kcentra is primarily used for urgent reversal of vitamin K antagonist therapy in adult patients with acute major bleeding or need for urgent surgery 2. The European Association of Cardiothoracic Anaesthesiology recommends an initial bolus of 25 IU/kg for most scenarios, with consideration of a reduced dose (12.5 IU/kg) in patients at high risk for thromboembolic complications 3.

Unlike some medications that can be absorbed through alternative routes, Kcentra's efficacy depends entirely on intravenous delivery to provide immediate availability of coagulation factors in the circulation.

Important Considerations

• Kcentra does not reverse the activity of direct oral Xa inhibitors (like rivaroxaban) despite providing coagulation factors 2
• If infiltration occurs, the patient has not received the intended therapeutic dose
• A new dose calculation may be needed based on the estimated amount infiltrated
• Document the infiltration incident according to institutional protocols