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

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