Intraosseous administration of 4‐factor prothrombin complex concentrate prior to emergent surgery after receiving apixaban

What is known and objective The 4‐factor prothrombin complex concentrate (4F‐PCC) may be used to emergently achieve haemostasis in patients on anticoagulation prior to surgery. Limited data exist using the intraosseous route of administration of 4F‐PCC in patients taking factor Xa inhibitors. Case description We describe a case of a 69‐year‐old female receiving oral apixaban that was successfully administered 4F‐PCC using intraosseous access prior to emergent surgery to obtain haemostasis intraoperatively. What is new and conclusion Intraosseous access may be a viable route of administration for 4F‐PCC in patients receiving factor Xa inhibitors to achieve haemostasis when necessary. We present a case of a 69 year old female on chronic oral anticoagulation with apixaban in need of emergent surgery. Adequate peripheral intravenous access could not be obtained in a timely manner necessitating the use of 4‐factor prothrombin complex concentrate via the intraosseous route. The intraosseous route may be a viable option to achieve hemostasis effectively and safely.