What is known and objective: The 4-factor prothrombin complex concentrate (4F-PCC) may be used to emergently achieve haemostasis in patients on anticoagulation prior to surgery. Limited data exist using the intraosseous route of administration of 4F-PCC in patients taking factor Xa inhibitors.
Case description:We describe a case of a 69-year-old female receiving oral apixaban that was successfully administered 4F-PCC using intraosseous access prior to emergent surgery to obtain haemostasis intraoperatively.
What is new and conclusion:Intraosseous access may be a viable route of administration for 4F-PCC in patients receiving factor Xa inhibitors to achieve haemostasis when necessary. K E Y W O R D S anticoagulation, apixaban, haemostasis, intraosseous, prothrombin complex concentrate R E FE R E N C E S 1. Sikorska J, Uprichard J. Direct oral anticoagulants: a quick quide. Eur Cardiol. 2017;12(1):40-45. https ://doi.
Treatment of DOAC-induced bleeding remains an "off-label" indication for PCC. Additional doses should be given with caution if given at all and patients monitored closely.
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