PCCs are plasma-derived factor concentrates originally developed to treat factor IX deficiency (hemophilia B). Three- factor PCC contains factors II, IX, and X whereas 4-factor PCC also contains factor VII. PCC does not require cross matching, can be reconstituted and administered rapidly in a small volume (20 40 mL), and has been processed to inactivate infectious agents. Several studies have shown that PCCs rapidly normalize the INR (within minutes) in patients Although nonrandomized retrospective reviews and a small case-control study have shown more rapid correction of INR with vitamin K and PCC than vitamin K and FFP, none have clearly demonstrated an improvement in patient clinical outcome with PCC.83 85 In 1 randomized trial comparing the use of a PCC (Konyne) to supplement FFP versus FFP alone in patients with VKA-related ICH, those who were given FFP alone received a higher volume of FFP and developed more adverse events, primarily attributable to PCCs may increase the risk of thrombotic complications, although this risk appears low.80 In 2013, the first large phase 3 randomized controlled trial demonstrated noninferiority of 4-factor PCC to FFP for urgent reversal of warfarin in a cohort of 202 patients with acute bleeding (24 of whom had intracranial hemorrhage).87 In this study, the rate of achieving an INR <1.3 within 30 minutes of completing ther- apy was 62.2% for PCC and 9.6% for FFP. Thromboembolic event rates were similar (7.8% with PCC and 6.4% with FFP), and fluid overload was more common with FFP (12.8% versus 4.9%). Analogous randomized trials have not been performed to directly evaluate 3-factor and 4-factor PCCs against each other. 