Four-factor prothrombin complex concentrate (4F-PCC) reverses bleeding associated with the new direct oral anticoagulants (NOACs) dabigatran, rivaroxaban, edoxaban and apixaban in a rabbit model

Background: To summarize the efficacy of the non-activated four-factor PCC (4F-PCC) *Beriplex®/Kcentra® (CSL Behring) in controlling acute NOAC-associated bleeding in an in vivo rabbit model. To evaluate correlations between in vivo measures of haemostasis and in vitro coagulation parameters. Main conclusions: In this rabbit model of acute haemorrhage 4F-PCC, administered at a clinically relevant dose range, showed potential for reversing NOAC-associated bleeding for all NOACs tested, including direct FIIa inhibitor dabigatran, and FXa inhibitors edoxaban, rivaroxaban and apixaban. These data suggest that 4F-PCC may be an option for the urgent reversal of the anticoagulant effect of NOACs. Further clinical data in human patients are required to confirm these results.