Correction of INR by prothrombin complex concentrate and vitamin K in patients with warfarin related hemorrhagic complication

Thromb Res. 2002 Oct 1;108(1):25-30. doi: 10.1016/s0049-3848(02)00402-4.


We investigated the effect of prothrombin complex concentrate (PCC, median 500 IU) and vitamin K (10-20 mg) or either on blood coagulation and clinical findings in 17 patients with major hemorrhagic complication during warfarin treatment. Their international normalized ratio (INR) at admission was median 2.7 (2.0-above 10.0). In 11 patients treated with PCC and vitamin K, INR decreased to median 1.13 (0.91-1.36) 10 min after the administration with elevation of plasma levels of coagulant factors II, VII, IX, X and protein C.INR decreased abruptly after the administration of PCC without vitamin K in two patients but it increased again 12-24 h after, with decrease of coagulant factors levels. In one of them, a hematoma of the brain enlarged with INR re-increase 12-24 h after the administration. In four patients treated with vitamin K alone, INR decreased slowly from 2.69 (1.03-3.35) to 1.28 (1.25-1.44) 12-24 h after the administration in parallel with gradual increase of the coagulant factors.PCC administration with or without vitamin K seems to be more effective in rapidly correcting increased INR levels than vitamin K treatment without PCC. PCC without vitamin K may result in re-increase of INR and clinical deterioration.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Coagulation Factors / administration & dosage
  • Blood Coagulation Factors / therapeutic use*
  • Brain / diagnostic imaging
  • Cerebral Hemorrhage / blood
  • Cerebral Hemorrhage / chemically induced
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / drug therapy
  • Female
  • Hemorrhage / blood
  • Hemorrhage / chemically induced*
  • Hemorrhage / drug therapy*
  • Humans
  • International Normalized Ratio
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed
  • Vitamin K / administration & dosage
  • Vitamin K / therapeutic use*
  • Warfarin / adverse effects*


  • Blood Coagulation Factors
  • Vitamin K
  • prothrombin complex concentrates
  • Warfarin