Prothrombin complex concentrate versus fresh-frozen plasma for reversal of coagulopathy of trauma

Is there a difference?

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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1875-1881
Number of pages7
JournalWorld Journal of Surgery
Volume38
Issue number8
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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International Normalized Ratio
Wounds and Injuries
Costs and Cost Analysis
Therapeutics
Propensity Score
Injury Severity Score
Blood Coagulation Factors
Mortality
prothrombin complex concentrates
Trauma Centers
Warfarin
Research Design
Erythrocytes
Demography
Databases

ASJC Scopus subject areas

  • Surgery

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Prothrombin complex concentrate versus fresh-frozen plasma for reversal of coagulopathy of trauma : Is there a difference? / Joseph, Bellal; Aziz, Hassan; Pandit, Viraj; Hays, Daniel; Kulvatunyou, Narong; Yousuf, Zeeshan; Tang, Andrew; OKeeffe, Terence; Green, Donald; Friese, Randall S.; Rhee, Peter.

In: World Journal of Surgery, Vol. 38, No. 8, 01.01.2014, p. 1875-1881.

Research output: Contribution to journalArticle

Joseph, B, Aziz, H, Pandit, V, Hays, D, Kulvatunyou, N, Yousuf, Z, Tang, A, OKeeffe, T, Green, D, Friese, RS & Rhee, P 2014, 'Prothrombin complex concentrate versus fresh-frozen plasma for reversal of coagulopathy of trauma: Is there a difference?', World Journal of Surgery, vol. 38, no. 8, pp. 1875-1881. https://doi.org/10.1007/s00268-014-2631-y
Joseph, Bellal ; Aziz, Hassan ; Pandit, Viraj ; Hays, Daniel ; Kulvatunyou, Narong ; Yousuf, Zeeshan ; Tang, Andrew ; OKeeffe, Terence ; Green, Donald ; Friese, Randall S. ; Rhee, Peter. / Prothrombin complex concentrate versus fresh-frozen plasma for reversal of coagulopathy of trauma : Is there a difference?. In: World Journal of Surgery. 2014 ; Vol. 38, No. 8. pp. 1875-1881.
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abstract = "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.",
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T1 - Prothrombin complex concentrate versus fresh-frozen plasma for reversal of coagulopathy of trauma

T2 - Is there a difference?

AU - Joseph, Bellal

AU - Aziz, Hassan

AU - Pandit, Viraj

AU - Hays, Daniel

AU - Kulvatunyou, Narong

AU - Yousuf, Zeeshan

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Green, Donald

AU - Friese, Randall S.

AU - Rhee, Peter

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

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