1. Kcentra In-service Adam M. Spaulding, PharmD, BCPS
Emergency Medicine Pharmacist
Waterbury Hospital

2. Clinical Use FDA indication:
Emergent reversal of bleeding due to Vitamin K Antagonists
Emergent reversal of anticoagulation prior to emergent procedures
Un-labeled indications:
Emergent reversal of direct Xa inhibitors (+/- DTIs)
Bloodless surgery

3. Our Protocol
Ordering and dosing
Preparation
Administration

4. Our protocol Kcentra Restrictions Inclusion Criteria:
Restrictions for use at Waterbury Hospital
Kcentra Restrictions
Inclusion Criteria:
Treatment of life-threatening bleeding or major bleeding associated with hemodynamic instability in patients taking warfarin, rivaroxaban or apixaban (including those who present with intracranial hemorrhage and declining neurologic status)
Rapid correction of INR in patients receiving warfarin and who required immediate reversal for life-sustaining procedures (anticipated need within 8 hours)
Exclusion Criteria:
Known history of heparin-induced thrombocytopenia
Disseminated intravascular coagulation is suspected
Able to tolerate FFP volume and slower time of onset
Bleeding due to dabigatran (advise the physician over the phone)
Bleeding in the absence of an anticoagulant

5. Dosing VKA reversal: Based on INR and weight (kg) INR 2-4: 25units/kg
Direct Xa inhibitors: Empirically weight-based
Clinical presentation/history: 25-50units/kg
>1 dose not studied, not recommended and not approved at WH

6. Dosing Cheat Sheet

7. Administration
Europe: given bedside via syringe (each vial pushed slowly over 2-3 minutes) USA (and WH): Contents pooled in a bag and infused at 8.4mL/min (500mL/hr) Follow by mL NS at same rate MUST BE GIVEN WITH VITAMIN K

8. Administer within 4 hours of reconstitution
Administration
Administer within 4 hours of reconstitution
Dedicated line required for administration
2 separate lines preferable (one for Vitamin K)
Administered as an 500ml/hr
After infusion, the line needs to be flushed with NS
Replace Kcentra with cc bag NS and run at same rate
Need f/u INR 30 minutes after infusion