From the Guidelines
KCentra is generally preferred over Fibeba for urgent reversal of anticoagulation due to its more comprehensive factor replacement profile, which provides more reliable hemostasis in emergency bleeding situations. The most recent and highest quality study, published in 2024 in the Journal of Thrombosis and Haemostasis 1, suggests that four-factor prothrombin complex concentrates, such as KCentra, have improved hemostatic efficacy compared to other reversal agents. KCentra contains factors II, VII, IX, and X along with proteins C and S, making it more comprehensive than Fibeba, which typically contains fewer clotting factors. For vitamin K antagonist reversal, KCentra is dosed based on INR and weight, typically 25-50 units/kg, and for direct oral anticoagulant reversal, a fixed dose of 50 units/kg is often used. KCentra works rapidly, with effects seen within minutes and lasting 12-24 hours, as noted in the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1.
Some key points to consider when choosing between Fibeba and KCentra include:
- The type of anticoagulant being reversed, with KCentra being preferred for vitamin K antagonists and direct oral anticoagulants
- The patient's INR and weight, which guide KCentra dosing
- The risk of thromboembolism, which is associated with both products but may be higher with Fibeba, as suggested by a retrospective analysis of 4395 patients 1
- The need for concurrent vitamin K administration to provide sustained reversal once the effects of the PCC wear off, as recommended in the 2021 ACC/AHA guideline 1.
Overall, the choice between Fibeba and KCentra should be based on the individual patient's clinical scenario and the potential benefits and risks of each product, with KCentra being the generally preferred option due to its more comprehensive factor replacement profile and improved hemostatic efficacy.
From the Research
Fieba vs Kcentra
- Fieba, also known as activated prothrombin complex concentrate (aPCC), and Kcentra, also known as 4-factor prothrombin complex concentrate (4PCC), are both used for the reversal of warfarin-associated bleeding 2.
- A study comparing the effectiveness of 3-factor to 4-factor prothrombin complex concentrates found that 4-factor products were more reliable in correcting international normalized ratio (INR) values 3.
- Another study found that 4PCC was associated with greater achievement of INR ≤ 1.5 compared to aPCC, with comparable thrombotic events and mortality 2.
- Kcentra (4PCC) has been shown to be effective in reversing warfarin-related intracranial hemorrhage, with most patients receiving single doses and adjunctive reversal agents 4.
- The tolerability and effectiveness of 4F-PCC (Kcentra) have been evaluated in a real-world setting, with variable thromboembolic and hemostatic effectiveness rates based on the indication for reversal 5.
Key Differences
- The main difference between Fieba (aPCC) and Kcentra (4PCC) is the number of clotting factors they contain, with 4PCC containing four clotting factors (II, VII, IX, and X) and aPCC containing only three clotting factors (II, IX, and X) 3, 2.
- The choice between Fieba and Kcentra may depend on the specific clinical scenario and the patient's individual needs, with 4PCC potentially being more effective in certain situations 2, 4.
Clinical Use
- Both Fieba and Kcentra are used for the urgent reversal of warfarin-associated bleeding, with Kcentra being specifically approved for this indication 6, 4.
- The dosing practices for Kcentra (4PCC) can vary between institutions, with some using dose rounding policies and others preparing exact doses 4.
- The use of Fieba (aPCC) and Kcentra (4PCC) should be guided by clinical guidelines and institutional protocols, with careful consideration of the potential risks and benefits 3, 5.