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Table 4 Use of PCCs to reverse the anticoagulant effect of DOACs: summary of guidelines and proposals

From: The impact of prothrombin complex concentrates when treating DOAC-associated bleeding: a review

Society/group (citation) Need for DOAC reversal Guidelines or proposals regarding the use of PCCs
Thrombosis and Hemostasis Summit of North America [113] Critical bleeding or emergent surgery • Use of PCCs seems to be a reasonable approach in dire clinical situations
• Consensus was not reached because two authors believed that PCC could not be recommended due to absence of data at the time
Task Force for Advanced Bleeding Care in Trauma [117] Life-threatening bleeding • PCC (25–50 IU/kg) suggested for reversal of FXa inhibitors
• Not suggested for patients treated with dabigatran
European Society of Cardiology; European Heart Rhythm Association [111, 112] Life-threatening bleeding • Administration of PCC (25 IU/kg, repeated if clinically indicated) or aPCC (50 IU/kg) can be considered
European Society of Anaesthesiology [114] Life-threatening bleeding or ICH • PCC or aPCC suggested
Australasian Society of Thrombosis and Haemostasis [118] Life- or limb-threatening bleeding • Reasonable to consider the use of PCCs; risk and benefit of these agents should be assessed in each individual patient
Groupe d’Intérêt en Hémostase Périopératoire (GIHP; working group on perioperative haemostasis) [115] ICH, or haemorrhage in a critical organ • Use of aPCC (30–50 IU/kg) or PCC (50 IU/kg) warranted, possibly re-administered once after an 8-h interval
Emergent surgery • PCCs should not be used for prophylactic reversal of anticoagulation, but PCC (25–50 IU/kg) or aPCC (30–50 IU/kg) should be considered to control perioperative bleeding events
Groupe d’Intérêt en Hémostase Périopératoire (GIHP; working group on perioperative haemostasis) [109] Major intraoperative bleeding • Multimodal approach, including 4F-PCC (25–50 IU/kg) or aPCC (30–50 IU/kg) administration
American Heart Association; American Stroke Association [78] ICH • aPCC or PCC may be considered on an individual basis
Neurocritical Care Society; Society of Critical Care Medicine [110] ICH • 4F-PCC (50 IU/kg) or aPCC (50 IU/kg) is suggested for FXa inhibitor-associated ICH
• aPCC (50 IU/kg) or 4F-PCC (50 IU/kg) is suggested for dabigatran-associated ICH (if idarucizumab is not available)
Anticoagulation Forum [108] Severe haemorrhage • 4F-PCC (50 IU/kg) or aPCC (80 IU/kg) may be considered for reversal of direct FXa inhibitors and direct thrombin inhibitors, respectively
American Heart Association [116] Serious bleeding or ICH • 4F-PCC (50 IU/kg) is suggested for the treatment of patients receiving FXa inhibitors until more specific antidotes bcome available
  1. 4F-PCC four-factor prothrombin complex concentrate, aPCC activated prothrombin complex concentrate, F factor, h hour, ICH intracranial haemorrhage, IU international unit, PCC prothrombin complex concentrate