Q: What is the difference between 3 factor or 4 factor PCCs (prothrombin-complex concentrates)?


Answer:  PCCs (prothrombin-complex concentrates) are used in reversal of acute bleeding from warfarin, particularly in intracranial bleeds. They have advantage of be effective within minutes (usually 10 minutes).

Factors  II, IX, X and VII are four vitamin K-dependent factors.

• Three factor PCCs contain coagulation factors II, IX, and X
• Four factor PCCs contain coagulation factors II, IX, X and VII 

Though data is not very strong but there is a weak evidence that correction of INR is more reliable with four-factor PCC than with three-factor PCC.



References: 

1. Bershad EM, Suarez JI. Prothrombin complex concentrates for oral anticoagulant therapy-related intracranial hemorrhage: a review of the literature. Neurocrit Care 2010; 12:403. 

2. Voils SA, Baird B. Systematic review: 3-factor versus 4-factor prothrombin complex concentrate for warfarin reversal: does it matter? Thromb Res 2012; 130:833.