3-Factor Vs. 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three

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Abstract

Introduction:

Coagulopathy of trauma(COT) is common and highly lethal. Prothrombin complex concentrate(PCC) has been advocated for correction of COT. However, the difference in efficacy between 3-factor PCC(3-PCC) vs. 4-factor PCC(4-PCC) remains unclear. The aim of our study was to compare efficacy of 3-PCC vs. 4-PCC in COT.

Methods:

5-year(2013-2017) review of coagulopathic trauma patients at our Level-I trauma center who received 3- or 4-PCC. Patients were divided into two groups(4-PCC and 3-PCC) and matched in 1:1 ratio using propensity-score-matching for demographics, injury parameters, admission vitals and hematological parameters. Primary outcomes were time to correction of INR, blood products transfusion, thromboembolic complications, and mortality. Secondary outcomes were hospital-LOS, ICU-LOS, cost of therapy, and total hospital cost.

Results:

657 patients met inclusion criteria of which 250 patients(4-PCC:125; 3-PCC:125) were matched. The mean age was 50 ± 19.4y, 64% were male, and median-ISS was 24[15-33]. 4-PCC was associated with accelerated correction of INR(365mins vs. 428mins,p  =  0.01), decrease in pRBC(7units vs. 10units,p  =  0.04) and FFP(6units vs. 8units,p  =  0.03) transfused. There was no difference in platelet transfusion, thromboembolic complications, mortality, hospital and ICU-LOS. 4-PCC was associated with higher cost of PCC therapy, and lower cost of transfusion. There was no difference regarding the total hospital cost between the two groups.

Conclusion:

Compared to 3-factor PCC, the use of 4-factor PCC is associated with a rapid reversal of INR and reduction in transfusion requirement without increasing the overall hospital cost or the risk of thromboembolic events. 4-PCC may be preferred as an adjunct for the resuscitation of coagulopathic trauma patients.

Level of Evidence:

Level III, Therapeutic studies.

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