FEIBA (Activated PCC)
FEIBA
Activated prothrombin complex concentrate (aPCC)
Contains activated factor VII plus factors II, IX, X → 'bypasses' factor VIII/IX. Used for hemophilia with inhibitors and some DOAC-associated bleeding.
Indications
- •Hemophilia A/B with inhibitors (bleeding + surgical coverage)
- •Off-label factor Xa inhibitor–associated life-threatening bleeding
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Hemophilia with inhibitors | 50–100 units/kg IV q6–12h (max 200 units/kg/day) | — |
Pharmacokinetics
Onset minutes. Thrombin-generation effect outlasts measurable factor levels.
Side effects
- !Thrombosis, DIC, MI (dose-dependent)
- !Do NOT combine with emicizumab (thrombotic microangiopathy)
Contraindications
- ×DIC
- ×Concurrent emicizumab (relative — thrombotic risk)
- ×Normal coagulation
Clinical pearls
- ★For hemophilia patients WITH inhibitors — bypasses the missing/blocked factor.
- ★Thrombogenic — do not exceed max daily dose; avoid with emicizumab.
Other drugs in Coagulation Related
- Heparin (unfractionated)
Activates antithrombin → inactivates IIa (thrombin) and Xa.
- Tranexamic Acid (TXA)
Reversibly binds plasminogen, blocking conversion to plasmin → preserves fibrin clot.
- Protamine Sulfate
Strongly basic (positive-charge) protein binds to highly acidic (negative-charge) heparin → inactive ionic complex → renal excretion. 1 mg protamine neutralizes ~100 units heparin.
- DDAVP (Desmopressin)
Selective V2 agonist (renal water retention + Factor VIII/vWF release from endothelial Weibel-Palade bodies). NO V1 vasopressor activity at therapeutic dose.
- Warfarin
Inhibits vitamin K epoxide reductase (VKORC1) → depletes reduced vitamin K → ↓ synthesis of factors II, VII, IX, X and proteins C/S. Full effect takes days (waits for existing factor decay).
- Enoxaparin
Antithrombin-mediated inhibition, weighted toward factor Xa over IIa (~3.8:1). More predictable than UFH — no routine monitoring.
- Dalteparin
Antithrombin-mediated factor Xa > IIa inhibition. Similar profile to enoxaparin; preferred LMWH in cancer-associated VTE (CLOT trial).
- Tinzaparin
Antithrombin-mediated factor Xa > IIa inhibition; higher mean molecular weight than enoxaparin (anti-Xa:IIa ~1.9:1).
Browse all classes: /reference/drugs
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
