Prothrombin complex concentrate
- 1 January 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Trauma and Acute Care Surgery
- Vol. 74 (1), 248-253
- https://doi.org/10.1097/ta.0b013e3182788a40
Abstract
Coagulopathy in patients with traumatic brain injury (TBI) is a well-studied concept. Prothrombin complex concentrate (PCC) has been shown to be an effective treatment modality for correction of TBI coagulopathy. However, its use and effectiveness compared with recombinant factor VII (rFVIIa) in TBI has not been established. The purpose of this study was to compare PCC and rFVIIa for the correction of TBI coagulopathy. All patients with a TBI and an induced or acquired coagulopathy whom received rFVIIa or PCC at our Level I trauma center during a 4-year period were reviewed. Data collected included demographics, changes in international normalized ratio and blood products transfusion, craniotomy rates, and time to neurosurgical intervention, thromboembolic complications, and mortality differences. The study was composed of 85 TBI patients, of whom 64 patients received PCC while 21 patients received rFVIIa. PCC group were more likely to be on coumadin (44% vs. 14%, p = 0.01). There was a significant decline in packed red blood cell transfusion and fresh frozen plasma after PCC administration (p < 0.01). There was no statistically significant difference in the craniotomy rate (28% vs. 10 %, p = 0.1) or the mean time to intervention between the two groups (201 [33] vs. 230 [10], p = 0.9). Mortality rates were lower in the PCC group compared with rFVIIa (67% vs. 47%, p = 0.02). Subsequent thromboembolic event was seen in one patient on rFVIIa. Mean cost of treatment per patient on PCC was $1,007 compared with $5,757 for rFVIIa (p < 0.01). PCC is safe and effective for treating coagulopathy in TBI patients, while reducing costs and resource use. PCC should be considered as an effective therapy to treat both acquired and induced coagulopathy in TBI with or without prehospital coumadin use. Therapeutic study, level IV.Keywords
This publication has 23 references indexed in Scilit:
- Trauma Induced CoagulopathyJournal of the Royal Army Medical Corps, 2009
- Resuscitation and transfusion principles for traumatic hemorrhagic shockBlood Reviews, 2009
- Reversal of Coagulopathy in Critically Ill Patients With Traumatic Brain Injury: Recombinant Factor VIIa is More Cost-Effective Than PlasmaThe Journal of Trauma and Acute Care Surgery, 2009
- Low-dose recombinant factor VIIa for trauma patients with coagulopathyInjury, 2008
- Recombinant Factor VIIa: Decreasing Time to Intervention in Coagulopathic Patients With Severe Traumatic Brain InjuryThe Journal of Trauma and Acute Care Surgery, 2008
- Damage Control Resuscitation: Directly Addressing the Early Coagulopathy of TraumaThe Journal of Trauma and Acute Care Surgery, 2007
- Efficacy of fibrinogen and prothrombin complex concentrate used to reverse dilutional coagulopathy—a porcine modelBritish Journal of Anaesthesia, 2006
- Factor VIIa for Correction of Traumatic CoagulopathyThe Journal of Trauma and Acute Care Surgery, 2004
- The Effect of Temperature and pH on the Activity of Factor VIIa: Implications for the Efficacy of High-Dose Factor VIIa in Hypothermic and Acidotic PatientsThe Journal of Trauma and Acute Care Surgery, 2003
- Extracranial complications of severe head injuryJournal of Neurosurgery, 1992