Journal article
Use of Prothrombin Complex Concentrate as an Adjunct to Fresh Frozen Plasma Shortens Time to Craniotomy in Traumatic Brain Injury Patients
Neurosurgery, Vol.76(5), pp.601-607
05/2015
DOI: 10.1227/NEU.0000000000000685
PMID: 25886249
Abstract
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.ABBREVIATIONS:AIS, Abbreviated Injury ScaleFFP, fresh frozen plasmaINR, international normalized ratioPCC, prothrombin complex concentraterFVIIa, recombinant factor VIIaRHCT, repeat head computed tomography scanSD, standard deviationTBI, traumatic brain injury
Details
- Title: Subtitle
- Use of Prothrombin Complex Concentrate as an Adjunct to Fresh Frozen Plasma Shortens Time to Craniotomy in Traumatic Brain Injury Patients
- Creators
- Bellal Joseph - University of ArizonaViraj Pandit - University of ArizonaMazhar Khalil - University of ArizonaNarong Kulvatunyou - University of ArizonaHassan Aziz - University of ArizonaAndrew Tang - University of ArizonaTerence O'Keeffe - University of ArizonaDaniel Hays - University of ArizonaLynn Gries - University of ArizonaMichael Lemole - University of ArizonaRandall S. Friese - University of ArizonaPeter Rhee - University of Arizona
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.76(5), pp.601-607
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1227/NEU.0000000000000685
- PMID
- 25886249
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Number of pages
- 7
- Language
- English
- Date published
- 05/2015
- Academic Unit
- Surgery
- Record Identifier
- 9984701552102771
Metrics
4 Record Views