Urgent Warfarin Reversal — EECC MCQ
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Correct answer: E — Four-factor prothrombin complex concentrate (PCC) — provides rapid and complete INR reversal within 15-30 minutes; IV vitamin K (5-10 mg) should be co-administered for sustained reversal
Four-factor PCC provides the fastest and most complete reversal of warfarin. It contains factors II, VII, IX, and X (plus proteins C and S), directly replacing the vitamin K-dependent factors depleted by warfarin. INR normalisation occurs within 15-30 minutes (compared to 6-8 hours for IV vitamin K alone, and 12-24 hours for oral vitamin K). The BCSH and ESC guidelines recommend PCC as first-line for urgent/emergency warfarin reversal (major bleeding, emergency surgery). IV vitamin K must be co-administered because PCC effects are transient (factor VII half-life ~6 hours), while vitamin K provides sustained factor synthesis. FFP is no longer recommended first-line due to volume overload risk, slow administration, and incomplete reversal.
Reference: BCSH Guidelines; ESC (2024): AF Guidelines