Pre hospital administration of prothrombin complex concentrate in the head injured patient, a service evaluation

Prothrombin complex concentrate (PCC), provides rapid reversal of warfarin anticoagulation [1] and has been shown to reduce mortality and haematoma expansion secondary to non-traumatic intracerebral haemorrhage, in warfarinised patients [2]. The measurement of international normalised ratio (INR) and administration of PCC to warfarinised patients with an INR >2 and suspected intracranial haemorrhage, are interventions currently undertaken by London’s Air Ambulance (LAA). The feasibility of these interventions is illustrated by a case study of pre hospital administration of PCC and a service evaluation of their utilisation is presented.