TY - JOUR
T1 - Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients
AU - Joseph, Bellal
AU - Pandit, Viraj
AU - Khalil, Mazhar
AU - Kulvatunyou, Narong
AU - Aziz, Hassan
AU - Tang, Andrew
AU - OKeeffe, Terence
AU - Hays, Daniel
AU - Gries, Lynn
AU - Lemole, Michael
AU - Friese, Randall S.
AU - Rhee, Peter
N1 - Publisher Copyright:
© 2015 by the Congress of Neurological Surgeons.
PY - 2015/5/21
Y1 - 2015/5/21
N2 - BACKGROUND: The use of prothrombin complex concentrate (PCC) to reverse acquired (coagulopathy of trauma) and induced coagulopathy (preinjury warfarin use) is well defined. OBJECTIVE: To compare outcomes in patients with traumatic brain injury without warfarin therapy receiving PCC as an adjunct to fresh frozen plasma (FFP) therapy compared with patients receiving FFP therapy alone. METHODS: All patients with traumatic brain injury coagulopathy without warfarin therapy who received PCC (25 IU/kg) in conjunction with FFP or FFP alone at our Level I trauma center were reviewed. Coagulopathy was defined as an international normalized ratio >1.5. The groups (PCC + FFP vs FFP alone) were matched using propensity score matching on a 1:2 ratio for age, sex, Glasgow Coma Scale score, Injury Severity Score, head Abbreviated Injury Scale score, and international normalized ratio (INR) on presentation. The primary outcome measure was time to craniotomy. Secondary outcome measures were blood product requirements, cost of therapy, and mortality. RESULTS: A total of 1641 patients were reviewed, 222 of whom were included (PCC + FFP, 74; FFP, 148). The mean ± standard deviation age was 46.4 ± 21.7 years, the median (range) Glasgow Coma Scale score was 8 (3-12), and the mean ± standard deviation INR on presentation was 1.92 ± 0.6. PCC + FFP therapy was associated with an accelerated correction of INR (P .001) and decrease in overall pack red blood cell (P .035) and FFP (P .041) administration requirement. Craniotomy was performed in 26.1% of patients (n 58). Patients who received PCC + FFP therapy had faster time to craniotomy (P .028) compared with patients who received FFP therapy alone. CONCLUSION: PCC as an adjunct to FFP decreases the time to craniotomy with faster correction of INR and concomitant decrease in the need for blood product requirement in patients with traumatic brain injury exclusive of prehospital warfarin therapy.
AB - BACKGROUND: The use of prothrombin complex concentrate (PCC) to reverse acquired (coagulopathy of trauma) and induced coagulopathy (preinjury warfarin use) is well defined. OBJECTIVE: To compare outcomes in patients with traumatic brain injury without warfarin therapy receiving PCC as an adjunct to fresh frozen plasma (FFP) therapy compared with patients receiving FFP therapy alone. METHODS: All patients with traumatic brain injury coagulopathy without warfarin therapy who received PCC (25 IU/kg) in conjunction with FFP or FFP alone at our Level I trauma center were reviewed. Coagulopathy was defined as an international normalized ratio >1.5. The groups (PCC + FFP vs FFP alone) were matched using propensity score matching on a 1:2 ratio for age, sex, Glasgow Coma Scale score, Injury Severity Score, head Abbreviated Injury Scale score, and international normalized ratio (INR) on presentation. The primary outcome measure was time to craniotomy. Secondary outcome measures were blood product requirements, cost of therapy, and mortality. RESULTS: A total of 1641 patients were reviewed, 222 of whom were included (PCC + FFP, 74; FFP, 148). The mean ± standard deviation age was 46.4 ± 21.7 years, the median (range) Glasgow Coma Scale score was 8 (3-12), and the mean ± standard deviation INR on presentation was 1.92 ± 0.6. PCC + FFP therapy was associated with an accelerated correction of INR (P .001) and decrease in overall pack red blood cell (P .035) and FFP (P .041) administration requirement. Craniotomy was performed in 26.1% of patients (n 58). Patients who received PCC + FFP therapy had faster time to craniotomy (P .028) compared with patients who received FFP therapy alone. CONCLUSION: PCC as an adjunct to FFP decreases the time to craniotomy with faster correction of INR and concomitant decrease in the need for blood product requirement in patients with traumatic brain injury exclusive of prehospital warfarin therapy.
KW - Fresh frozen plasma
KW - Prothrombin complex concentrate
KW - Time to craniotomy
KW - Traumatic brain injury
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U2 - 10.1227/NEU.0000000000000685
DO - 10.1227/NEU.0000000000000685
M3 - Article
C2 - 25886249
AN - SCOPUS:84928153085
SN - 0148-396X
VL - 76
SP - 601
EP - 607
JO - Neurosurgery
JF - Neurosurgery
IS - 5
ER -