A. If 4-factor prothrombin complex concentrate (4F PCC) is available (preferred approach): |
1. Give 4F PCC* 1500 to 2000 units¶ IV over 10 minutes. Check INR 15 minutes after completion of the infusion. If INR is not ≤1.5, give additional 4F PCC (refer to topic or drug reference for details). |
2. Give vitamin K 10 mg IV over 10 to 20 minutes. |
B. If 3-factor prothrombin complex concentrate (3F PCC) is available but 4F PCC is not available: |
1. Give 3F PCC* 1500 to 2000 units¶ IV over 10 minutes. Check INR 15 minutes after completion of the infusion. If INR is not ≤1.5, give additional 3F PCC (refer to topic or drug reference for details). |
2. Give Factor VIIa 20 mcg/kg IV OR give FFP 2 units IV by rapid infusion. Factor VIIa may be preferred if volume overload is a concern. |
3. Give vitamin K 10 mg IV over 10 to 20 minutes. |
C. If neither 3F PCC nor 4F PCC is available: |
1. Give FFP 2 units IV by rapid infusion. Check INR 15 minutes after completion of infusion. If INR ≥1.5, administer 2 additional units of FFP IV rapid infusion. Repeat process until INR ≤1.5. May wish to administer loop diuretic between FFP infusions if volume overload is a concern. |
2. Give vitamin K 10 mg IV over 10 to 20 minutes. |