Journal Article

Prothrombin Complex Concentrate Versus Fresh-Frozen Plasma for Reversal of Coagulopathy of Trauma: Is There a Difference?

O’Keeffe, Terence, Friese, Randall S., Yousuf, Zeeshan, Kulvatunyou, Narong, Rhee, Peter, Hays, Daniel, Pandit, Viraj, Tang, Andrew, Aziz, Hassan, Joseph, Bellal, Green, Donald

2014

Overview

Introduction The development of coagulopathy of trauma is multifactorial associated with hypoperfusion and consumption of coagulation factors. Previous studies have compared the role of factor replacement versus FPP for reversal of trauma coagulopathy. The purpose of our study was to determine the time to correction of coagulopathy and blood product requirement in patients who received PCC+FFP compared with patients who received FFP alone. Methods We performed a retrospective analysis of a prospectively maintained database of all coagulopathic (INR ≥ 1.5) trauma patients presenting to our level I trauma center during a 2-years period (2011–2012). Patients were stratified into two groups: patients who received PCC+FFP and patients who received FFP alone. Patients in the two groups were matched in a 1:3 (PCC+FFP:FFP) ratio using propensity score matching for demographics, injury severity, vital parameters, and initial INR. The two groups were then compared for: correction of INR, time to correction of INR, thromboembolic complications, mortality, and cost of therapy. Results A total of 252 were included in the analysis [PCC+FFP:63; FFP:189]. The mean age was 44 ± 20 years; 70 % were male, with a median ISS score of 27 [16–38]. PCC use was associated with an accelerated correction of INR (394 vs. 1,050 min; p 0.001), reduction in requirement of pack red blood cell (6.6 vs. 10 units; p 0.001) and FFP (2.8 vs. 3.9 units; p 0.01), and decline in mortality (23 vs. 28 %; p 0.04). PCC+FFP use was associated with a higher cost of therapy ($1,470 ± 845 vs. 1,171 ± 949; p 0.01) but lower overall cost of transfusion ($7,110 ± 1,068 vs. 9,571 ± 1,524; p 0.01) compared with FFP therapy alone. Conclusions PCC in conjunction with FFP rapidly corrects INR in a matched cohort of trauma patients not on warfarin therapy compared with FFP therapy alone. The use of PCC as an adjunct to FFP therapy is associated with reduction of blood product requirement and also lowers overall cost.

• Publisher: Springer US,John Wiley & Sons, Inc
• Subject: Abdominal Surgery / Adult / Aged / Blood Coagulation Disorders - etiology / Blood Coagulation Disorders - therapy / Blood Coagulation Factors - therapeutic use / Blood Transfusion / Cardiac Surgery / Factor Replacement / Female / General Surgery / Hematologic Agents - therapeutic use / Humans / International Normalize Ratio / Male / Matched-Pair Analysis / Medicine / Medicine & Public Health / Middle Aged / Plasma / Propensity Score / Propensity Score Match / Retrospective Studies / Surgery / Thoracic Surgery / Time Factors / Trauma Patient / Treatment Outcome / Vascular Surgery / Wounds and Injuries - complications