Safety of Prothrombin Complex Concentrates for Rapid Reversal of Anticoagulation with Vitamin K Antagonists: A Meta-analysis
Another caveat: a word of caution about embracing this 4-factor PCC for all bleeds. It should be reserved for individuals with truly life-threatening or severe hemorrhage. That is because it can actually cause thrombosis. This does not happen very often, but in the meta-analysis of 27 studies, reviewed in Figure 25, the overall rate of thrombotic events (including pulmonary embolisms, myocardial infarctions, and stroke) was about 1.4%.[18]
Certainly faced with a severe hemorrhage that is threatening a patient's life, the healthcare giver is going to do whatever possible to stop the bleed, but the physician should still realize that with PCCs there is a small risk of thrombosis.
References
Crowther M, Mathur V, Kitt M, et al. A Phase 2 randomized, double-blind, placebo-controlled trial demonstrating reversal of rivaroxaban-induced anticoagulation in healthy subjects by andexanet alfa (PRT064445), an antidote for FXa inhibitors. Blood. 2013;122:3636.