{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:19:47Z","timestamp":1792199987207,"version":"4.4.0"},"reference-count":76,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T00:00:00Z","timestamp":1594944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Modern four\u2010factor prothrombin complex concentrate was designed originally for rapid targeted replacement of the coagulation factors II, VII, IX and X. Dosing strategies for the approved indication of vitamin K antagonist\u2010related bleeding vary greatly. They include INR and bodyweight\u2010related protocols as well as fixed dose regimens. Particularly in the massively bleeding trauma and cardiac surgery patient, four\u2010factor prothrombin complex concentrate is used increasingly for haemostatic resuscitation. Members of the Transfusion and Haemostasis Subcommittee of the European Association of Cardiothoracic Anaesthesiology performed a systematic literature review on four\u2010factor prothrombin complex concentrate. The available evidence has been summarised for dosing, efficacy, drug safety and monitoring strategies in different scenarios. Whereas there is evidence for the efficacy of four\u2010factor prothrombin concentrate for a variety of bleeding scenarios, convincing safety data are clearly missing. In the massively bleeding patient with coagulopathy, our group recommends the administration of an initial bolus of 25\u00a0IU.kg\n                    <jats:sup>\u20101<\/jats:sup>\n                    . This applies for: the acute reversal of vitamin K antagonist therapy; haemostatic resuscitation, particularly in trauma; and the reversal of direct oral anticoagulants when no specific antidote is available. In patients with a high risk for thromboembolic complications, e.g. cardiac surgery, the administration of an initial half\u2010dose bolus (12.5\u00a0IU.kg\n                    <jats:sup>\u20101<\/jats:sup>\n                    ) should be considered. A second bolus may be indicated if coagulopathy and microvascular bleeding persists and other reasons for bleeding are largely ruled out. Tissue\u2010factor\u2010activated, factor VII\u2010dependent and heparin insensitive point\u2010of\u2010care tests may be used for peri\u2010operative monitoring and guiding of prothrombin complex concentrate therapy.\n                  <\/jats:p>","DOI":"10.1111\/anae.15181","type":"journal-article","created":{"date-parts":[[2020,7,18]],"date-time":"2020-07-18T01:29:40Z","timestamp":1595035780000},"page":"381-392","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["A European consensus statement on the use of four\u2010factor prothrombin complex concentrate for cardiac and non\u2010cardiac surgical patients"],"prefix":"10.1111","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6742-1016","authenticated-orcid":false,"given":"G.","family":"Erdoes","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Pain Medicine Inselspital Bern University Hospital University of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Koster","sequence":"additional","affiliation":[{"name":"Institute for Anaesthesiology, Heart and Diabetes Centre NRW Ruhr\u2010University Bochum Bad Oeynhausen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Ortmann","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Kerckhoff Heart and Lung Centre Bad Nauheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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