Prothrombin complex concentrates
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Fatal myocardial infarction?: case report A 52-year-old man, who had been receiving warfarin for 4 years, was hospitalised with bowel perforation, and required urgent surgery. He received one 500IU vial of prothrombin complex concentrate [PCC; Beriplex P/N] and vitamin K for correction of his coagulation parameters. Four hours later, his INR was 1.7 and his activated partial thromboplastin time was1.47 [units not stated], and surgery was started. He underwent partial colonic resection without complication, but he became hypotensive and experienced a fatal cardiorespiratory arrest immediately before wound closure. An autopsy showed acute myocardial infarction (MI) with moderate atherosclerosis of all coronary arteries, and moderate ventricular hypertrophy. Author comment: "In this case, it is difficult to determine the extent to which PCC contributed to the adverse outcome. Firstly, MI is a frequent peri-operative complication in the absence of PCC usage. Furthermore, fatal MI occurred in this patient more than five hours following PCC administration." Bagot CN, et al. Perioperative myocardial infarction in a patient receiving lowdose prothrombin complex concentrates. Thrombosis and Haemostasis 98: 801095311 1141-1142, No. 5, Nov 2007 - England
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Reactions 12 Jan 2008 No. 1184
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