Massive, Fatal, Intracardiac Thrombosis Associated With Prothrombin Complex Concentrate

Prothrombin complex concentrates are frequently used to rapidly reverse anticoagulation with vitamin K antagonists associated with life-threatening bleeding. We report a patient receiving warfarin who presented to the emergency department with an international normalization ratio greater than 12.8 in cardiac tamponade and received prothrombin complex concentrate for rapid reversal of anticoagulation. On correction of the tamponade, the patient developed a massive and fatal right-sided ventricular thrombus. Thrombogenic complications of treatment with prothrombin complex concentrate have been reported before. Caution should be used when using prothrombin complex concentrates for reversal of anticoagulation.