Prothrombin complex concentrates (Prothrombin, Factor 7, Factor 9, Factor 10):
(1) Konyne 80
(2) Profilnine HT
(3) Proplex T
(4) Bebulin VH
dose of prothrombin complex concentrate in IU =
= ((target level of prothrombin complex as a percent from 0 to 100) - (current estimate of the prothrombin complex in percent)) * (body weight in kilograms)
number of vials of concentrate to inject =
= (dose in IU) / (concentration of factors in IU per vial)
total volume in mL =
= (number of vials) * (volume per vial in mL)
where:
• The body weight is a surrogate marker for plasma volume.
• A small dose of vitamin K may also be administered.
• An equation to calculate the prothrombin complex activity from the INR is available in section 04.05.02 .
One issue with this approach is that while Factor 9 is present in a relatively standard amount, the levels of the other coagulation factors in each product can vary. Factor 7 is low relative to Factor 9 (11-20 IU vs 100 IU) and the other factors in Konyne 80, Profilnine HT and Bebulin VH, but is high in Proplex T (400 IU vs 100 IU). One solution would be to replace part of the dose with Proplex T and the remainder with one of the other concentrates. This may not be necessary since (1) usually only a small level of coagulation factors is required to prevent bleeding and (2) vitamin K may also be administered.
Because the level of activity for each of the 4 factors is different, the amount of each factor administered will be different. One option is to dose based on the Factor 9 content; another would be to take the mean value for all of the factors. This aspect has been avoided in the implementation.
The prothrombin complex concentrate must be given IV. It should be administered slowly, not exceeding 2-3 mL per minute. If the rate is too high the patient may experience flushing, a change in pulse, a change in blood pressure or other symptoms. These can usually be controlled by slowing the rate of infusion.
Bebulin V and Proplex T contain a small amount of heparin, which may be a problem if the patient has heparin-associated antibodies. I do not see heparin listed in Konyne 80 or Profilnine HT in the PDR.
