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Prothrombin Complex Concentrate in Direct Oral Anticoagulant Reversal: A Systematic Scoping Review

Nazedah Ain Ibrahim1, Jiaa Yinn Tang2, Hayati Alwani Yahaya2

  • 1Department of Pharmacy, Hospital Tunku Azizah, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia.

The Journal of Emergency Medicine
|July 4, 2025
PubMed

Insights

Prothrombin complex concentrates (PCC) can reverse direct oral anticoagulants (DOAC) when specific agents are unavailable. This review examines PCC effectiveness and safety for DOAC reversal in Malaysia.

Area of Science:

  • Pharmacology
  • Hematology
  • Clinical Medicine

Background:

  • Direct oral anticoagulants (DOAC) are alternatives to warfarin for anticoagulation.
  • Malaysia lacks widespread availability of specific DOAC reversal agents like idarucizumab and andexanet alfa.
  • Prothrombin complex concentrates (PCC) are recommended for life-threatening DOAC bleeding in the absence of specific agents.

Purpose of the Study:

  • To evaluate the effectiveness and safety of PCC in reversing DOAC.
  • To provide insights into the current use of PCC for DOAC reversal in Malaysia.

Main Methods:

  • A scoping review of studies from 2016-2020 using PubMed, Wiley, Sage, and Google Scholar.
  • Inclusion of clinical studies on PCC utilization for DOAC reversal, adhering to PRISMA extension for Scoping Reviews.
  • Study registered with the National Medical Research Register, Malaysia.

Main Results:

  • Twenty studies met inclusion criteria, all describing PCC use for DOAC reversal (25-50 u/kg doses).
  • Hemostatic effectiveness was reported in 15 studies, often using International Society on Thrombosis and Haemostasis (ISTH) criteria.
  • All 20 studies assessed PCC safety, including thrombotic events and mortality risks.

Conclusions:

  • High-quality research is needed to further understand PCC effectiveness and safety for hemostasis.
  • PCC serves as a viable option for DOAC reversal when specific agents are unavailable or the DOAC type is unknown.
Abstract

Keywords:
Direct oral anticoagulant reversalHemostasisProthrombin complex concentrateReversalThrombotic events

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