From the Guidelines
Kcentra should be administered in emergency situations to rapidly reverse the effects of vitamin K antagonists in adult patients with acute major bleeding or who need urgent surgery or invasive procedures, as soon as possible after the decision to treat, alongside vitamin K to maintain the reversal effect. The dosage of Kcentra ranges from 25-50 units/kg based on the patient's INR level and body weight, with a maximum dose of 5000 units, as recommended by the 2020 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants 1. Administration should occur via slow intravenous infusion at a rate not exceeding 8.4 mL/minute (210 units/minute), and patients should be monitored for signs of thrombosis, as Kcentra carries a risk of thromboembolic events. Some key points to consider when administering Kcentra include:
- The medication works by immediately replacing deficient coagulation factors II, VII, IX, and X, providing much faster reversal than fresh frozen plasma.
- Kcentra is preferred over plasma due to its higher concentration of vitamin K-dependent factors and faster infusion rate 1.
- The use of Kcentra should be accompanied by the administration of vitamin K to maintain the reversal effect, as vitamin K does not result in immediate correction of coagulopathy 1.
- Patients with known hypersensitivity to Kcentra components or a history of heparin-induced thrombocytopenia should not receive Kcentra. It is essential to weigh the benefits of Kcentra administration against the potential risks, particularly the risk of thromboembolic events, and to carefully monitor patients for signs of adverse effects.
From the Research
Administration of Kcentra
Kcentra, a 4-factor prothrombin complex concentrate (PCC), is used for the reversal of warfarin anticoagulation. The following are key points to consider when administering Kcentra:
- Kcentra should be administered in situations where urgent warfarin reversal is necessary, such as in cases of major bleeding or when invasive procedures are required 2.
- The efficacy of Kcentra in correcting supratherapeutic international normalized ratio (INR) values has been demonstrated in several studies, with more reliable correction of INR seen with 4-factor PCCs compared to 3-factor PCCs 3.
- Kcentra can be administered with or without vitamin K, but administration with vitamin K may be more effective in rapidly correcting increased INR levels and preventing re-increase of INR 4.
- A fixed, low-dose of activated PCC (aPCC), such as Kcentra, has been shown to be safe and effective in reversing the effects of warfarin in patients with traumatic intracranial hemorrhage 5.
Key Considerations
When administering Kcentra, the following should be considered:
- The patient's INR value and clinical presentation should guide the decision to administer Kcentra 6.
- Kcentra should be administered as soon as possible after the diagnosis of warfarin-related bleeding is made 2.
- The use of Kcentra may be associated with a lower risk of thrombotic adverse events compared to fresh frozen plasma (FFP) 2.