Kcentra (human prothrombin complex concentrate) is a medication derived from human plasma that contains unactivated factors II, VII, IX, X, protein C, protein S, antithrombin III, and heparin. In 2013, it gained FDA approval for the urgent reversal of acquired factor deficiency from vitamin K antagonism (ie, Coumadin) in the context of acute major bleeding in adult patients.
Kcentra’s dose depends on the current INR and patient’s body weight, and it should be co-administered with vitamin K. Data does not support redosing Kcentra!
By understanding what Kcentra is, the contraindications make sense. Don’t use it in a patient with heparin-induced thrombocytopenia (because Kcentra contains heparin). Don’t use it in disseminated intravascular coagulation (DIC) as the addition of coagulation factors will be “adding fuel to the fire.” Instead, treating DIC hinges on addressing the underlying problem. As always, be mindful of anaphylatic/hypersensitivity reactions!
Of note, KCentra is pooled from human plasma. Therefore, this may not be a therapeutic option in many Jehovah’s Witness patients.
I use Kcentra all the time in the operating room for coagulopathy in trauma and large cardiothoracic operations. In the ICU, I most often use it to reverse supratherapeutic INRs in the context of internal or gastrointestinal bleeding.
Drop me a comment below with questions! 🙂