From the Guidelines
Yes, Prothrombin Complex Concentrate (PCC) (Kcentra) can lower International Normalized Ratio (INR) in patients on Apixaban (Eliquis).
Reversal of Apixaban with PCC
- The dosage of PCC for reversal of apixaban is based on the clinical scenario, with specific dosing recommendations provided for different situations, such as major bleeding or the need for urgent surgery 1.
- According to the 2023 ACC/AHA/ACCP/HRS guideline, PCC can be used for the urgent reversal of apixaban in patients with acute major bleeding or those requiring urgent surgery/invasive procedures 1.
- The recommended dosing for PCC in patients on apixaban is based on the time since the last dose of apixaban and the dose of apixaban, with specific recommendations provided in the guideline 1.
Clinical Evidence
- A study published in the Journal of the American College of Cardiology in 2020 provides guidance on the management of bleeding in patients on oral anticoagulants, including the use of PCC for reversal of apixaban 1.
- The study recommends administering andexanet alfa as the first-line treatment for reversal of apixaban, but notes that PCC can be used as an alternative if andexanet alfa is not available 1.
Important Considerations
- When using PCC to reverse apixaban, it is essential to monitor the patient's INR and adjust the dosing as needed to ensure adequate reversal of anticoagulation 1.
- The use of PCC for reversal of apixaban should be guided by the clinical scenario and the patient's individual needs, with consideration given to the potential risks and benefits of treatment 1.
From the Research
Effect of Prothrombin Complex Concentrate on INR
- The use of Prothrombin Complex Concentrate (PCC) has been studied in the context of reversing anticoagulation in patients on warfarin, but its effectiveness in patients on Apixaban (Eliquis) is less clear.
- A study from 2019 2 found that 4-factor PCC was effective in achieving clinical hemostasis in patients on apixaban or rivaroxaban presenting with major bleeding, suggesting that PCC may be useful in reversing the effects of these direct oral anticoagulants.
Reversal of Anticoagulation with PCC
- PCC has been shown to rapidly correct increased INR levels in patients on warfarin, with studies demonstrating a significant decrease in INR after administration of PCC 3, 4, 5.
- The effectiveness of PCC in reversing anticoagulation in patients on apixaban is supported by the study from 2019 2, which found that 4-factor PCC achieved clinical hemostasis in 72.4% of patients with major bleeding.
Limitations and Considerations
- While the available evidence suggests that PCC may be effective in reversing anticoagulation in patients on apixaban, further studies are needed to fully understand its effects and optimal dosing.
- The use of PCC in patients on apixaban should be considered on a case-by-case basis, taking into account the individual patient's clinical presentation and medical history.