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Comprehensive Analysis of Procoagulant Platelets Exhibiting Features of Necrosis, Apoptosis and Platelet Activation
Published on: May 23, 2025
Massive, fatal, intracardiac thrombosis associated with prothrombin complex concentrate
1Department of Emergency Medicine, Alameda County Medical Center, Oakland, CA 94612, USA. Otis.warren@gmail.com
Annals of Emergency Medicine
|February 3, 2009
Summary
Prothrombin complex concentrates rapidly reverse warfarin anticoagulation but carry a risk of thrombotic complications. A patient developed a fatal ventricular thrombus after receiving PCC for cardiac tamponade, highlighting the need for caution.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Vitamin K antagonists like warfarin are crucial for preventing thromboembolic events.
- Rapid reversal of anticoagulation is sometimes necessary in life-threatening bleeding scenarios.
- Prothrombin complex concentrates (PCC) are a common option for urgent anticoagulation reversal.
Observation:
- A warfarin-treated patient presented with cardiac tamponade and a high International Normalized Ratio (INR > 12.8).
- The patient received prothrombin complex concentrate for rapid anticoagulation reversal.
- Following successful tamponade management, a massive right ventricular thrombus developed.
Findings:
- The development of a massive, fatal right ventricular thrombus occurred post-PCC administration.
- This case highlights a potentially severe thrombogenic complication associated with PCC use.
- Previous reports suggest thrombotic events are a known risk of PCC treatment.
Implications:
- Clinicians should exercise caution when administering prothrombin complex concentrates for anticoagulation reversal.
- Risk-benefit assessment is critical, especially in patients with underlying cardiac conditions.
- Further research into minimizing thrombotic risks associated with PCC is warranted.
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