Additional time is required to thaw frozen plasma and determine a patient’s blood type. Four bags of plasma is approximately 1000 mL and must be administered much more slowly to prevent circulatory overload. For example, a typical dose of 2000 units of Kcentra is reconstituted to a volume of 80 mL and is given IV push.
Kcentra reduces INR and increases vitamin K dependent coagulation factor levels more rapidly than plasma and with much smaller volume. Repeat dosing with Kcentra is not supported by clinical data and is not recommended. Kcentra is indicated for emergent reversal of acquired coagulation factor deficiency induced by warfarin in adult patients with acute major bleeding or who need urgent surgery or another invasive procedure. Kcentra is the brand name for a four factor Prothrombin Complex Concentrate which contains vitamin K dependent coagulation factors II, VII, IX and X and the antithrombotic Proteins C and S. In December, FDA extended its approval to include reversal of warfarin therapy for patients who require urgent, invasive medical procedures. In April 2013, FDA approved the use of Kcentra for the urgent reversal of acquired coagulation deficiency due to warfarin treatment among adult patients with acute major bleeding. Plasma transfusion is largely ineffective in correcting an INR of 2.2 or below.
As documented in the May 2012 issue of the Clinical Laboratory Letter, the higher the INR the greater the correction per unit of plasma. Even though IV administration of vitamin K begins to noticeably correct the INR within two hours after administration, plasma is often ordered for emergency reversal of warfarin induced anticoagulation. Vitamin K is the only specific antidote to warfarin. Warfarin inhibits the vitamin K dependent pathway that is necessary to synthesize functional coagulation factors II, VII, IX and X and the antithrombotic Proteins C and S.
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