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01-08-2018 | Original Scientific Report

Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients

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

Published in: World Journal of Surgery | Issue 8/2018

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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Title: Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients
Authors: Moustafa Younis
Mohamed Ray-Zack
Nadeem N. Haddad
Asad Choudhry
Matthew C. Hernandez
Kevin Wise
Martin D. Zielinski
Publication date: 01-08-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4520-2

At a glance: The STEP trials

Springer Medicine

Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients

Abstract

Background

Methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of evidence

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