| Product | Composition | Indications | Comments |
|---|---|---|---|
| FFP | All coagulation factors | Multiple factor deficiencies (eg, in DIC, liver disease) | May be required in large volumes to sufficiently boost levels of a single coagulation factor |
| FV deficiency (may supplement with platelet transfusions) | Not virally inactivated | ||
| FXI deficiency (in lieu of FXI concentrate when there is a heightened risk of thrombogenicity [eg, in the peripartum period])70 | |||
| Other single-factor deficiencies when single-factor concentrates or PCCs are unavailable | |||
| Cryoprecipitate | Concentrate precipitated from FFP; rich in FVIII, VWF, FXIII, and fibrinogen72 | Used most often to replace fibrinogen72 | May be required in large volumes |
| Not virally inactivated | |||
| PCCs | Highly purified concentrates from pooled normal plasma containing FII, FIX, and FX (±FVII)74,75 | FII or FX deficiency | Virally inactivated74,75 |
| FIX or FVII* deficiencies when single-factor concentrates are unavailable | Contain known amounts of each factor74,75 | ||
| 4-factor PCCs are indicated for warfarin reversal | |||
| Activated PCCs | PCC with FII, FIX, and FX (mainly nonactivated) and FVII (mainly in the activated form) | Coagulation factor inhibitors† | |
| Single-factor concentrates | Plasma derived | Respective single-factor deficiencies | Treatment of choice for single-factor deficiencies, when available |
| FVIII | rFVIIa is indicated as a bypassing agent for FVIII and FIX inhibitors,† as well as for replacing FVII in FVII deficiency | Risk for human viral contamination is present but exceedingly low in plasma-derived concentrates because of screening and viral inactivation procedures; it is probably nonexistent in recombinant concentrates | |
| FVIII/VWF | |||
| FIX | |||
| FXIII | |||
| Fibrinogen | |||
| Recombinant | |||
| rFVIIa | |||
| rFVIII | |||
| rFIX | |||
| rFXIII |
↵* Only 4-factor prothrombin complex concentrates (PCCs) may be used for replacement of factor VII (FVII); however, 4-factor PCCs are not universally available.
↵† Although single-factor concentrates may be used for respective low-titer coagulation factor inhibitors (eg, plasma-derived or recombinant factor VIII [FVIII] for FVIII inhibitors), bypassing agents are generally recommended for active bleeding (for which they are considered first-line therapy) and for hemostatic coverage during invasive procedures in patients with inhibitors.
DIC, disseminated intravascular coagulation; FFP, fresh frozen plasma; F, factor; PCC, prothrombin complex concentrate; rF, recombinant factor; VWF, von Willebrand factor.