Effectiveness of 4-Factor Prothrombin Complex Concentrate with and without Vitamin K in Managing Warfarin-Associated Major Bleeding

Background: Major bleeding is a common and severe complication associated with vitamin K antagonist use. Rapid reversal of anticoagulation is crucial in cases of acute bleeding. Prothrombin complex concentrates (PCC) have emerged as an effective option. This study examines the efficacy of 4-factor PCC (4F-PCC) alone and in combination with vitamin K for International Normalized Ratio (INR) control in patients with life-threatening bleeding due to warfarin. Methods: This retrospective cross-sectional study included 50 patients who presented with bleeding and coagulopathy to the Ondokuz Mayıs University Health Practice and Research Center Adult Emergency Department between January 1, 2022, and January 1, 2023. Patients were divided into 2 groups based on vitamin K administration within 24 hours: group 1 received only 4F-PCC, while group 2 received both 4F-PCC and vitamin K. Results: The median age of patients was 72 years, 56% were male. The most common indication for warfarin use was heart valve disease (54%). Gastrointestinal hemorrhage was the leading cause of bleeding (44%). Mortality was 26%, with all deaths occurring within 72 hours of admission. Group 2 had significantly lower INR levels at 24th-hour than group 1 (P=.048). No significant differences were found in INR levels between the 1st and 24th hours within either group (P > .05). Conclusion: The study demonstrates that the combination of 4F-PCC and vitamin K is more effective in controlling INR than 4F-PCC alone, though it does not significantly impact rebound INR increases. Further prospective, multicenter studies are needed to confirm these findings and explore long-term outcomes.