Thromboembolic complications and risk factors after fresh frozen plasma and prothrombin complex concentrate...

Rapid reversal of anticoagulation in life-threatening bleeding often requires prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). However, these treatments may increase the risk of thromboembolic complications (TEC). This study evaluated TEC incidence and risk factors in patients receiving PCC or FFP in the emergency department.

We retrospectively analyzed adults (≥18 years) presenting with major bleeding related to oral anticoagulants between May 2022 and October 2024.Patients receiving PCC or FFP for anticoagulation reversal were included.Demographic data, bleeding sites, anticoagulant use, laboratory values, and TECs (early: ≤72 h, late: ≤60 days) were collected. Statistical significance was set at p < 0.05.

Among 315 patients (mean age 76.9 years, 55.9% female), 42.5% received PCC and 57.5% FFP. Warfarin was the most common anticoagulant (74.3%). TEC occurred in 8.3% of patients (PCC: 6.7%, FFP: 9.4%; p = 0.39). Common TECs included myocardial infarction (1.9%), unstable angina (1.9%), and ischemic stroke (1.9%). No significant differences in TEC incidence were observed between groups (p > 0.05). Only valvular heart disease was associated with increased TEC risk (p = 0.04). PCC led to significantly faster correction of coagulation parameters (p < 0.01).

PCC use for urgent anticoagulation reversal in major bleeding was not associated with increased TEC risk compared with FFP. Given advanced age and comorbidities in this population, thromboembolic events may reflect baseline risk rather than reversal agent choice. Careful monitoring and timely resumption of anticoagulation are essential.