Skip to main content
SpringerLink
Log in

Prothrombin Complex Concentrate Versus Fresh-Frozen Plasma for Reversal of Coagulopathy of Trauma: Is There a Difference?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Spinella PC, Holcomb JB (2009) Resuscitation and transfusion principles for traumatic hemorrhagic shock. Blood Rev 23:231–240

    Article  PubMed Central  PubMed  Google Scholar 

  2. Joseph B, Amini A, Friese RS (2012) Factor IX complex for the correction of traumatic coagulopathy. J Trauma Acute Care Surg 72(4):828–834

    CAS  PubMed  Google Scholar 

  3. Joseph B, Hadjizacharia P, Aziz H et al (2013) Prothrombin complex concentrate: an effective therapy in reversing the coagulopathy of traumatic brain injury. J Trauma Acute Care Surg 74(1):248–253

    Article  CAS  PubMed  Google Scholar 

  4. Brohi K, Cohen MJ, Ganter MT (2007) Acute coagulopathy of trauma initiated by hypoperfusion modulated through the protein C pathway. Ann Surg 245(5):812–818

    Article  PubMed Central  PubMed  Google Scholar 

  5. Darlington DN, Craig T, Gonzales MD et al (2013) Acute coagulopathy of trauma in the rat. Shock 39(5):440–446

    Article  CAS  PubMed  Google Scholar 

  6. Dickneite G, Pragst I (2009) Prothrombin complex concentrate vs fresh frozen plasma for reversal of dilutional coagulopathy in a porcine trauma model. Br J Anaesth 102:345–354

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Dickneite G, Dorr B, Kaspereit F, Tanaka K (2010) Prothrombin complex concentrate versus recombinant factor VIIa for reversal of hemodilutional coagulopathy in a porcine trauma model. J Trauma 68:1151–1157

    Article  CAS  PubMed  Google Scholar 

  8. Stein DM, Dutton RP, Kramer ME, Handley C, Scalea TM (2008) Recombinant factor VIIa: decreasing time to neurosurgical intervention in patients with severe traumatic brain injury. J Trauma 64:620–628

    Article  CAS  PubMed  Google Scholar 

  9. Brown CV, Foulkrod KH, Lopez D (2010) Recombinant factor VIIa for the correction of coagulopathy before emergent craniotomy in blunt trauma patients. J Trauma 68(2):348–352

    Article  CAS  PubMed  Google Scholar 

  10. Stein DM, Dutton RP, Kramer ME, Scalea TM (2009) Reversal of coagulopathy in critically ill patients with traumatic brain injury: recombinant factor VIIa is more cost-effective than plasma. J Trauma 66(1):63–72

    Article  PubMed  Google Scholar 

  11. Joseph B, Aziz H, Zangbar B et al (2014) Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests: which laboratory values matter? J Trauma Acute Care Surg 76(1):121–125

    Article  PubMed  Google Scholar 

  12. Santry HP, Alam HB (2010) Fluid resuscitation: past, present, and the future. Shock 33(3):229–241

    Article  PubMed  Google Scholar 

  13. Holcomb JB, Jenkins D, Rhee P et al (2007) Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma Acute Care Surg 62(2):307–310

    Article  Google Scholar 

  14. Lauzier F, Cook D, Griffith L (2007) Fresh frozen plasma transfusion in critically ill patients. Crit Care Med 35(7):1655–1659

    Article  PubMed  Google Scholar 

  15. Demeyere R, Gillardin S, Arnout J et al (2010) Comparison of fresh frozen plasma and prothrombin complex concentrate for the reversal of oral anticoagulants in patients undergoing cardiopulmonary bypass surgery: a randomized study. Vox Sang 99(3):251–260

    Article  CAS  PubMed  Google Scholar 

  16. Sarode R, Matevosyan K, Bhagat R et al (2012) Rapid warfarin reversal: a 3-factor prothrombin complex concentrate and recombinant factor VIIa cocktail for intracerebral hemorrhage. J Neurosurg 116(3):491–497

    Article  CAS  PubMed  Google Scholar 

  17. Food and Drug Administration, Profilnine SD – Factor IX Complex, http://www.fda.gov/downloads/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/UCM261964.pdf

  18. Holland L, Warkentin TE, Refaai M et al (2009) Suboptimal effect of a three-factor prothrombin complex concentrate (Profilnine-SD) in correcting supratherapeutic international normalized ratio due to warfarin overdose. Transfusion 49(6):1171–1177

    Article  CAS  PubMed  Google Scholar 

  19. Joseph B, Zangbar B, Pandit V et al (2014) The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome. J Trauma Acute Care Surg 76(2):457–461

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study has not been supported by anyone. The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript.

Author information

Authors and Affiliations

  1. Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Avenue, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, US

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

Authors
  1. Bellal Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hassan Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Viraj Pandit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Hays
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Narong Kulvatunyou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zeeshan Yousuf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Terence O’Keeffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Donald Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Randall S. Friese
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Peter Rhee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bellal Joseph.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joseph, B., Aziz, H., Pandit, V. et al. Prothrombin Complex Concentrate Versus Fresh-Frozen Plasma for Reversal of Coagulopathy of Trauma: Is There a Difference?. World J Surg 38, 1875–1881 (2014). https://doi.org/10.1007/s00268-014-2631-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2631-y

Keywords

Search

Navigation