Original Contribution  |   December 2018
Utility of 4-Factor Prothrombin Complex Concentrate in Trauma and Acute-Care Surgical Patients
Author Notes
  • From the Departments of Surgery (Drs Sellers, Bendas, Toy, Klock, Badger, Jensen, and Becker) and Pharmacology (Dr Kerestes) at Geisinger Wyoming Valley Medical Center in Wilkes Barre, Pennsylvania; the Center for Health Research at Geisinger Medical Center in Danville, Pennsylvania (Ms Young); and the Michael E. DeBakey Department of Surgery at the Baylor College of Medicine in Houston, Texas (Dr Becker). 
  • The results of this study were presented at the Annual Clinical Assembly of the American College of Osteopathic Surgeons, September 22 to 25, in Phoenix, Arizona. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to William Sellers, DO, 265 N Grand St, Cobleskill, NY 12043-4127. Email: sellersw@gmail.com
     
Article Information
Emergency Medicine
Original Contribution   |   December 2018
Utility of 4-Factor Prothrombin Complex Concentrate in Trauma and Acute-Care Surgical Patients
The Journal of the American Osteopathic Association, December 2018, Vol. 118, 789-797. doi:10.7556/jaoa.2018.171
The Journal of the American Osteopathic Association, December 2018, Vol. 118, 789-797. doi:10.7556/jaoa.2018.171
Abstract

Context: Since 2013, prothrombin complex concentrate (PCCs) have been approved in the United States for the reversal of anticoagulation induced by vitamin K antagonists. However, there has been limited investigation into their use in trauma and acute-care surgery (ACS).

Objective: To investigate the role that 4-factor PCC may have in reversing anticoagulation in the setting of trauma and ACS.

Methods: All trauma and ACS patients who presented between March 14, 2014, and August 1, 2015, were included in this retrospective descriptive analysis. Patients receiving 4-factor PCC were compared with patients receiving fresh frozen plasma (FFP) alone. The following data were collected from medical records: age, sex, race, international normalized ratio (INR) at admission (baseline) and after reversal, blood products given, dosing of medication, injury severity score, length of stay, thromboembolic event, death during admission, and death within 90 days after admission.

Results: There were 188 trauma and ACS patients who required reversal of anticoagulation. Of these, 98 patients received FFP and 90 received PCC. Patients who received PCC were at increased risk for death during admission (20% vs 9.2% for FFP group) or within 90 days (39% vs 15%, respectively). Patients in the PCC group had a higher median baseline INR (2.9 vs 2.5 in the FFP group) and a lower postintervention INR (1.4 vs 1.8); consequently, the decrease in INR was greater in the PCC group than in the FFP group (1.5 vs 0.7, respectively). The number of total units of packed red blood cells transfused was significantly higher in patients receiving PCC.

Conclusion: Patients receiving PCC had worse outcomes than those who received FFP. Given that these differences may have resulted from baseline differences between groups, these results mandate further prospective analysis of the use of PCC in trauma and ACS patients.

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