Factor IX complex for the correction of traumatic coagulopathy

Bellal Joseph, Albert Amini, Randall S. Friese, Matthew Houdek, Daniel Hays, Narong Kulvatunyou, Julie Wynne, Terence OKeeffe, Rifat Latifi, Peter Rhee

Research output: Contribution to journalReview article

42 Citations (Scopus)

Abstract

BACKGROUND: Damage control resuscitation advocates correction of coagulopathy; however, options are limited and expensive. The use of prothrombin complex concentrate (PCC), also known as factor IX complex, can quickly accelerate reversal of coagulopathy at relatively low cost. The purpose of this study is to describe our experience in the use of factor IX complex in coagulopathic trauma patients. METHODS: All patients receiving PCC at our Level I trauma center over a two-year period (2008-2010) were reviewed. PCC was used at the discretion of the trauma attending for treatment of coagulopathy, reversal of coumadin, and when recombinant factor VIIa was indicated. RESULTS: Forty-five trauma patients received 51 doses of PCC. Sixty-two per cent were male and mean Injury Severity Score was 23 (±14.87). Standard dose was 25 units per kg and mean cost per patient was $1,022 ($504-3,484). Fifty-eight per cent of patients were on warfarin before admission. Mean international normalized ratio (INR) was decreased after PCC administration (p = 0.001). Packed red blood cell transfusion was also reduced after factor IX complex (p = 0.018). Mean INR was reduced in both the nonwarfarin (p = 0.001) and warfarin (p = 0.001) groups. Packed red blood cell transfusion was less in the nonwarfarin group (p = 0.002) however was not significant in the warfarin group. Subsequent thromboembolic events were observed in 3 of the 45 patients (7%). Mortality was 16 of 45 (36%). CONCLUSION: PCC rapidly and effectively treats coagulopathy after traumatic injury. PCC therapy leads to a significant correction in INR in all trauma patients, regardless of coumadin use, and concomitant reduction in blood product transfusion. PCC should be considered as an effective tool to treat acute coagulopathy of trauma. Further prospective studies examining the safety, efficacy, cost, and outcomes comparing PCC and recombinant factor VIIa are needed.

Original languageEnglish (US)
Pages (from-to)828-834
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number4
DOIs
StatePublished - Apr 1 2012
Externally publishedYes

Fingerprint

Factor IX
Warfarin
International Normalized Ratio
Wounds and Injuries
Erythrocyte Transfusion
Costs and Cost Analysis
prothrombin complex concentrates
Injury Severity Score
Trauma Centers
Resuscitation
Blood Transfusion
Prospective Studies
Safety
Mortality

Keywords

  • Damage control resuscitation
  • Factor IX complex
  • PCC
  • Shock
  • Trauma coagulopathy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Joseph, B., Amini, A., Friese, R. S., Houdek, M., Hays, D., Kulvatunyou, N., ... Rhee, P. (2012). Factor IX complex for the correction of traumatic coagulopathy. Journal of Trauma and Acute Care Surgery, 72(4), 828-834. https://doi.org/10.1097/TA.0b013e318247c944

Factor IX complex for the correction of traumatic coagulopathy. / Joseph, Bellal; Amini, Albert; Friese, Randall S.; Houdek, Matthew; Hays, Daniel; Kulvatunyou, Narong; Wynne, Julie; OKeeffe, Terence; Latifi, Rifat; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 72, No. 4, 01.04.2012, p. 828-834.

Research output: Contribution to journalReview article

Joseph, B, Amini, A, Friese, RS, Houdek, M, Hays, D, Kulvatunyou, N, Wynne, J, OKeeffe, T, Latifi, R & Rhee, P 2012, 'Factor IX complex for the correction of traumatic coagulopathy', Journal of Trauma and Acute Care Surgery, vol. 72, no. 4, pp. 828-834. https://doi.org/10.1097/TA.0b013e318247c944
Joseph B, Amini A, Friese RS, Houdek M, Hays D, Kulvatunyou N et al. Factor IX complex for the correction of traumatic coagulopathy. Journal of Trauma and Acute Care Surgery. 2012 Apr 1;72(4):828-834. https://doi.org/10.1097/TA.0b013e318247c944
Joseph, Bellal ; Amini, Albert ; Friese, Randall S. ; Houdek, Matthew ; Hays, Daniel ; Kulvatunyou, Narong ; Wynne, Julie ; OKeeffe, Terence ; Latifi, Rifat ; Rhee, Peter. / Factor IX complex for the correction of traumatic coagulopathy. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 72, No. 4. pp. 828-834.
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abstract = "BACKGROUND: Damage control resuscitation advocates correction of coagulopathy; however, options are limited and expensive. The use of prothrombin complex concentrate (PCC), also known as factor IX complex, can quickly accelerate reversal of coagulopathy at relatively low cost. The purpose of this study is to describe our experience in the use of factor IX complex in coagulopathic trauma patients. METHODS: All patients receiving PCC at our Level I trauma center over a two-year period (2008-2010) were reviewed. PCC was used at the discretion of the trauma attending for treatment of coagulopathy, reversal of coumadin, and when recombinant factor VIIa was indicated. RESULTS: Forty-five trauma patients received 51 doses of PCC. Sixty-two per cent were male and mean Injury Severity Score was 23 (±14.87). Standard dose was 25 units per kg and mean cost per patient was $1,022 ($504-3,484). Fifty-eight per cent of patients were on warfarin before admission. Mean international normalized ratio (INR) was decreased after PCC administration (p = 0.001). Packed red blood cell transfusion was also reduced after factor IX complex (p = 0.018). Mean INR was reduced in both the nonwarfarin (p = 0.001) and warfarin (p = 0.001) groups. Packed red blood cell transfusion was less in the nonwarfarin group (p = 0.002) however was not significant in the warfarin group. Subsequent thromboembolic events were observed in 3 of the 45 patients (7{\%}). Mortality was 16 of 45 (36{\%}). CONCLUSION: PCC rapidly and effectively treats coagulopathy after traumatic injury. PCC therapy leads to a significant correction in INR in all trauma patients, regardless of coumadin use, and concomitant reduction in blood product transfusion. PCC should be considered as an effective tool to treat acute coagulopathy of trauma. Further prospective studies examining the safety, efficacy, cost, and outcomes comparing PCC and recombinant factor VIIa are needed.",
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