Today, I have learned a drug Kcentra which can be useful in emergency cases for patients who need a quick reversal with high INR. I figured I would share it with you in case you haven’t heard it before. We have a patient today who is coming in for an emergent abdominal I&D. She is on coumadin and last dose taken was yesterday. Her INR from today was 3.2. She is in her late 70’s, morbidly obese, DM2 and has a history of CHF. The surgeon wanted to take her back ASAP. Considering her history of CHF, FFPs can’t be given quickly and there is an increased risk for her to exacerbate her CHF. This is where Kcentra comes in as it selectively restore the procoagulant and antithrombotic protein deficiencies induced by warfarin.
As the label shown above, Kcentra contains all 4 Vitamin-K dependent coagulation factors (II, VII, IX and X), and the Proteins C and S. These are the clotting factors which are inhibited by warfarin. There are several advantages of using it:
- There is no need for ABO typing and it can be reconstituted in solution and administered to quickly replenish the deficient circulating clotting factors.
- Volume given is significantly smaller compared to giving FFP plasma. It is in particular, an important consideration for patients who have significant cardiac comorbidity.
- It reduces the risk of transmission of infectious agents from plasma.
Kcentra is an effective alternative to plasma in this type of patient population and reversal therapy can be quickly achieved upon administration.
For dosing, please refer to the table below from the manufacturer’s website.
In clinical trials, 2% patients developed reactions to Kcentra observed in clinical trials included headache, nause/vomiting, hypotension and anemia. Rare complications include thromboembolic events, such as stroke, PE and DVT. In addition, Hypersensitivity reactions to Kcentra may occur. Kcentra is contraindicated in patients with DIC and HIT.
I hope you will find this information useful. Have a good weekend!