Prothrombin complex concentrate

An effective therapy in reversing the coagulopathy of traumatic brain injury

Bellal Joseph, Pantelis Hadjizacharia, Hassan Aziz, Narong Kulvatunyou, Andrew Tang, Viraj Pandit, Julie Wynne, Terence OKeeffe, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)248-253
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

Fingerprint

Therapeutics
Craniotomy
Warfarin
prothrombin complex concentrates
Traumatic Brain Injury
Erythrocyte Transfusion
Factor VII
International Normalized Ratio
Mortality
Trauma Centers
recombinant FVIIa
Blood Transfusion
Health Care Costs
Demography
Costs and Cost Analysis

Keywords

  • coagulopathy of trauma
  • craniotomy
  • Prothrombin concentrate complex
  • rFVIIa; traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Prothrombin complex concentrate : An effective therapy in reversing the coagulopathy of traumatic brain injury. / Joseph, Bellal; Hadjizacharia, Pantelis; Aziz, Hassan; Kulvatunyou, Narong; Tang, Andrew; Pandit, Viraj; Wynne, Julie; OKeeffe, Terence; Friese, Randall S.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 1, 01.01.2013, p. 248-253.

Research output: Contribution to journalArticle

Joseph, B, Hadjizacharia, P, Aziz, H, Kulvatunyou, N, Tang, A, Pandit, V, Wynne, J, OKeeffe, T, Friese, RS & Rhee, P 2013, 'Prothrombin complex concentrate: An effective therapy in reversing the coagulopathy of traumatic brain injury', Journal of Trauma and Acute Care Surgery, vol. 74, no. 1, pp. 248-253. https://doi.org/10.1097/TA.0b013e3182788a40
Joseph, Bellal ; Hadjizacharia, Pantelis ; Aziz, Hassan ; Kulvatunyou, Narong ; Tang, Andrew ; Pandit, Viraj ; Wynne, Julie ; OKeeffe, Terence ; Friese, Randall S. ; Rhee, Peter. / Prothrombin complex concentrate : An effective therapy in reversing the coagulopathy of traumatic brain injury. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 1. pp. 248-253.
@article{8ed7047e3b09495a85e9a9693a9cda78,
title = "Prothrombin complex concentrate: An effective therapy in reversing the coagulopathy of traumatic brain injury",
abstract = "BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. LEVEL OF EVIDENCE: Therapeutic study, level IV.",
keywords = "coagulopathy of trauma, craniotomy, Prothrombin concentrate complex, rFVIIa; traumatic brain injury",
author = "Bellal Joseph and Pantelis Hadjizacharia and Hassan Aziz and Narong Kulvatunyou and Andrew Tang and Viraj Pandit and Julie Wynne and Terence OKeeffe and Friese, {Randall S.} and Peter Rhee",
year = "2013",
month = "1",
day = "1",
doi = "10.1097/TA.0b013e3182788a40",
language = "English (US)",
volume = "74",
pages = "248--253",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Prothrombin complex concentrate

T2 - An effective therapy in reversing the coagulopathy of traumatic brain injury

AU - Joseph, Bellal

AU - Hadjizacharia, Pantelis

AU - Aziz, Hassan

AU - Kulvatunyou, Narong

AU - Tang, Andrew

AU - Pandit, Viraj

AU - Wynne, Julie

AU - OKeeffe, Terence

AU - Friese, Randall S.

AU - Rhee, Peter

PY - 2013/1/1

Y1 - 2013/1/1

N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. LEVEL OF EVIDENCE: Therapeutic study, level IV.

AB - BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. LEVEL OF EVIDENCE: Therapeutic study, level IV.

KW - coagulopathy of trauma

KW - craniotomy

KW - Prothrombin concentrate complex

KW - rFVIIa; traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=84872094662&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872094662&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3182788a40

DO - 10.1097/TA.0b013e3182788a40

M3 - Article

VL - 74

SP - 248

EP - 253

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -