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Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients

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Abstract

Background

Coagulopathy can delay or complicate surgical diseases that require emergent surgical treatment. Prothrombin complex concentrates (PCC) provide concentrated coagulation factors which may reverse coagulopathy more quickly than plasma (FFP) alone. We aimed to determine the time to operative intervention in coagulopathic emergency general surgery patients receiving either PCC or FFP. We hypothesize that PCC administration more rapidly normalizes coagulopathy and that the time to operation is diminished compared to FFP alone.

Methods

Single institution retrospective review was performed for coagulopathic EGS patients during 2/1/2008 to 8/1/2016. Patients were divided into three groups (1) PCC alone (2) FFP alone and (3) PCC and FFP. The primary outcome was the duration from clinical decision to operate to the time of incision. Summary and univariate analyses were performed.

Results

Coagulopathic EGS patients (n = 183) received the following blood products: PCC (n = 20, 11%), FFP alone (n = 119, 65%) and PCC/FFP (n = 44, 24%). The mean (± SD) patient age was 71 ± 13 years; 60% were male. The median (IQR) Charlson comorbidity index was similar in all three groups (PCC = 5(4–6), FFP = 5(4–7), PCC/FFP = 5(4–6), p = 0.33). The mean (± SD) dose of PCC administered was similar in the PCC/FFP group and the PCC alone group (2539 ± 1454 units vs. 3232 ± 1684, p = .09). The mean (±SD) time to incision in the PCC alone group was significantly lower than the FFP alone group (6.0 ± 3.6 vs. 8.8 ± 5.0 h, p = 0.01). The mean time to incision in the PCC + FFP group was also significantly lower than the FFP alone group (7.1 ± 3.6 vs. 8.8 ± 5.0, p = 0.03). The incidence of thromboembolic complications was similar in all three groups.

Conclusions

PCC, alone or in combination with FFP, reduced INR and time to surgery effectively and safely in coagulopathic EGS patients without an apparent increased risk of thromboembolic events, when compared to FFP use alone.

Level of evidence

IV single institutional retrospective review.

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Authors and Affiliations

  1. Division of Trauma, Critical Care and General Surgery, St. Mary’s Hospital, Mayo Clinic 200 First St SW, Rochester, MN, 55905, USA

    Moustafa Younis, Mohamed Ray-Zack, Nadeem N. Haddad, Asad Choudhry, Matthew C. Hernandez, Kevin Wise & Martin D. Zielinski

Authors
  1. Moustafa Younis
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  2. Mohamed Ray-Zack
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  3. Nadeem N. Haddad
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  4. Asad Choudhry
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  5. Matthew C. Hernandez
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  6. Kevin Wise
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  7. Martin D. Zielinski
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Contributions

MY wrote the first draft of the manuscript. Study design was developed by MY, KW, MR-Z, NHH, MH and MZ. Data generation was performed by Moustafa Younis, Mohamed Ray-Zack, and Nadeem H. Haddad. Data analysis and interpretation was performed by Moustafa Younis, Mohamed Ray-Zack, Matthew Hernandez and Martin Zielinski. Manuscript writing was performed by Moustafa Younis, Matthew Hernandez, Nadeem H. Haddad, Mohamed Ray-Zack and Martin Zielinski.

Corresponding author

Correspondence to Martin D. Zielinski.

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Conflict of interest

The authors do not have any potential conflicts of interest and no funding was utilized for the generation of this work. The authors do not have any honoraria, grants, or other form of payment was given to anyone to produce the manuscript.

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Younis, M., Ray-Zack, M., Haddad, N.N. et al. Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients. World J Surg 42, 2383–2391 (2018). https://doi.org/10.1007/s00268-018-4520-2

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