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
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC