Prothrombinex

CLASS

• human plasma derivative
• The 3 factor prothrombin complex concentrate available in Australia

MECHANISM OF ACTION

• provision of factors II, IX and X

PHARMACEUTICS

DOSE

• -> 25-50 IU\kg
  (1 IU\kg of Factor IX raises the Factor IX by 1%)

No Bleeding

• INR < 5 – reduce or omit dose
• INR 5-9 – cease dose + Vit K 2mg po or 1mg IV
• INR >9 – cease dose + Vit K 5mg po or 1mg IV, consider Prothrombin X 25-50 IU\kg, consider FFP 150-300mL

Bleeding

• Cease + 5-10mg IV Vit K + FFP 150-300mL

INDICATIONS

• bleeding and warfarinized
• bleeding from factor deficiency
• prophylaxis

ADVERSE EFFECTS

• allergy
• PE
• phlebitis
• DVT
• anaphylaxis
• vomiting
• fever
• rash
• urticaria
• SOB
• pain
• thrombocytopenia

PHARMACOKINETICS

• Absorption
• Distribution
• Metabolism
• Elimination

EVIDENCE

• Monitor INR >6 carefully
• Vit K works within 6-12 hours

Advantages

• small volume
• readily available
• reliable reversal
• avoids complications of FFP – immune reaction, TRALI, fever, infection risk
• familiarity
• cheap