Correction of INR by prothrombin complex concentrate and vitamin K in patients with warfarin related hemorrhagic complication

Abstract

We investigated the effect of prothrombin complex concentrate (PCC, median 500 IU) and vitamin K (10–20 mg) or either on blood coagulation and clinical findings in 17 patients with major hemorrhagic complication during warfarin treatment. Their international normalized ratio (INR) at admission was median 2.7 (2.0–above 10.0). In 11 patients treated with PCC and vitamin K, INR decreased to median 1.13 (0.91–1.36) 10 min after the administration with elevation of plasma levels of coagulant factors II, VII, IX, X and protein C. INR decreased abruptly after the administration of PCC without vitamin K in two patients but it increased again 12–24 h after, with decrease of coagulant factors levels. In one of them, a hematoma of the brain enlarged with INR re-increase 12–24 h after the administration. In four patients treated with vitamin K alone, INR decreased slowly from 2.69 (1.03–3.35) to 1.28 (1.25–1.44) 12–24 h after the administration in parallel with gradual increase of the coagulant factors. PCC administration with or without vitamin K seems to be more effective in rapidly correcting increased INR levels than vitamin K treatment without PCC. PCC without vitamin K may result in re-increase of INR and clinical deterioration.