Use of low-dose prothrombin complex concentrate before lumbar puncture
Skip to main page content HOME CURRENT ISSUE PAST ISSUES SUPPLEMENTS REPRINTS ALERTS KEYWORDS GO Advanced Search ? AdvertisementUse of low-dose prothrombin complex concentrate before lumbar puncture Jared J. Butler Jared J. Butler, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN (jared.butler{at}va.gov). Abstract Purpose The use of an off-label dose of four-factor prothrombin complex concentrate (PCC) for International Normalized Ratio (INR) reversal in a patient before a diagnostic lumbar puncture is reported. Summary A 57-year-old, 122-kg man arrived at the hospital with a possible diagnosis of meningitis and had an INR of >3 while on warfarin therapy. The patient initiated warfarin therapy in 2009 due to recurrent deep vein thrombosis. The patient required reversal of his elevated INR in order for a lumbar puncture to be safely performed (INR must be no higher than 1.4). Multiple units of fresh frozen plasma (FFP) were administered, with a subsequent INR decrease to 1.9. Additional units of FFP were given. The patient developed respiratory decompensation due to volume overload, partially caused by the administration of multiple units of FFP. As the INR remained above 1.4 but was less than 2, an alternative dosing strategy was used. A dose of 1020 units of factor IX, equaling about 10 mg/kg based on a maximum dosing weight of 100 kg, was administered. The two vials of PCC administered each contained 510 units of factor IX. No vitamin K was given. The patient’s INR, checked 30 minutes after PCC administration, was 1.3, and the lumbar puncture was performed. The lumbar puncture was completed without complication, and the patient was restarted on therapeutic anticoagulation the following day. Conclusion A 57-year-old patient was successfully treated with low-dose PCC to reverse an INR from 1.7 to 1.3 in order to perform a diagnostic lumbar puncture. Copyright ? 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
CiteULike 
Delicious 
Digg 
Facebook 
Google+ 
Reddit 
Twitter What's this? ? Previous | Next Article ? Table of Contents This Article doi: 10.2146/ajhp140310 American Journal of Health-System Pharmacy February 1, 2015 vol. 72 no. 3 203-205 ? Abstract Full Text Full Text (PDF) Classifications Print Content Case Reports Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Alert me when eLetters are published Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager eLetters Submit an eLetter No eLetters published Citing Articles Load citing article information Google Scholar Articles by Butler, J. J. PubMed PubMed citation Articles by Butler, J. J. Related Content Load related web page information Social Bookmarking CiteULike Delicious Digg Facebook Google+ Reddit Twitter What's this? Current Issue February 15, 2015, 72 (4) 
Alert me to new issues of American Journal of Health-System Pharmacy From the Cover RhOD immune globulin products for prevention of alloimmunization during pregnancy Sublingual tacrolimus as an alternative to oral administration for solid organ transplant recipients Economic burden of recurrent venous thromboembolism: Analysis from a U.S. hospital perspective Comparative analytics of infusion pump data across multiple hospital systems ABOUT AJHP SUBSCRIPTIONS FOR AUTHORS/REVIEWERS PERMISSION REQUESTS ADVERTISING EMAIL ALERTS (FREE) 
RSS FEEDS (FREE) 
HELP CONTACT US/FEEDBACK American Society of Health System Pharmacists Learning Center (CE) Store Meetings & Conferences ASHP Foundation MOST READ ARTICLES (Last 30 Days) Clinical practice guidelines for antimicrobial prophylaxis in surgery Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists How to write a patient case report Treatment of poisoning caused by {beta}-adrenergic and calcium-channel blockers ? View all Most Read articles Advertisement ? 2015 by the American Society of Health-System Pharmacists. Terms of Use | Copyright Online ISSN: 1535-2900 Print ISSN: 1079-2082 View the original article here
