Do you typically recommend four factor prothrombin complex concentrate versus fresh frozen plasma for INR correction in patients with vitamin K antagonist associated spontaneous ICH?

Great question! Despite the lack of large randomized controlled trials, PCCs achieve faster reversal of the INR level than FFPs do, and thus I favor using PCCs with Vitamin K as a first line agent for Vitamin K antagonist related ICH.

Not only that, but PCC also has significantly less volume than FFP, which also takes very long to administer because, as the name suggests, it is frozen and needs to be thawed. Because of all of these reasons, PCC has rapidly displaced FFP as the drug of choice in vitamin k antagonist-related bleedi...

Always PCC. FFP is a backup in case you can't get PCC for whatever reason.

Yes, prothrombin complex is more effective, has less volume, and is quicker to administer. The only downside is price, but in this case, that should be secondary.