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3-Factor Versus 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three
Muhammad Zeeshan1, Mohammad Hamidi, Narong Kulvatunyou
1Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
Insights
Four-factor prothrombin complex concentrate (4-PCC) offers faster correction of coagulopathy of trauma (COT) and reduces blood product transfusions compared to three-factor PCC (3-PCC). This improved efficacy does not increase overall hospital costs or thromboembolic risks.
Area of Science:
- Trauma and Emergency Medicine
- Hematology
- Pharmacology
Background:
- Coagulopathy of trauma (COT) is a significant cause of mortality.
- Prothrombin complex concentrate (PCC) is used to manage COT.
- The comparative efficacy of three-factor PCC (3-PCC) and four-factor PCC (4-PCC) in COT is not well-established.
Purpose of the Study:
- To compare the efficacy of 4-PCC versus 3-PCC in correcting coagulopathy of trauma.
- To evaluate differences in transfusion requirements, complication rates, and costs between 3-PCC and 4-PCC.
Main Methods:
- A retrospective review of coagulopathic trauma patients receiving 3-PCC or 4-PCC between 2013-2017.
- Propensity-score matching (1:1 ratio) was used to control for patient and injury characteristics.
- Primary outcomes included time to INR correction, blood product transfusion volumes, thromboembolic events, and mortality.
Main Results:
- Matched analysis of 250 patients (125 per group) showed 4-PCC significantly accelerated INR correction (365 vs. 428 min, P=0.01).
- 4-PCC use was associated with reduced red blood cell (7 vs. 10 units, P=0.04) and FFP (6 vs. 8 units, P=0.03) transfusions.
- No significant differences were observed in mortality, thromboembolic complications, or length of stay between the groups.
Conclusions:
- Four-factor PCC demonstrates superior efficacy in rapidly reversing coagulopathy of trauma compared to 3-PCC.
- 4-PCC reduces the need for blood product transfusions without increasing adverse events or overall hospital costs.
- 4-PCC may be the preferred agent for managing coagulopathy in trauma patients.
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 three-factor PCC (3-PCC) versus four-factor PCC (4-PCC) remains unclear. The aim of our study was to compare efficacy of 3-PCC versus 4-PCC in COT.
Methods:
Five-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 international normalized ratio (INR), blood products transfusion, thromboembolic complications, and mortality. Secondary outcomes were hospital-length of stay (LOS), intensive care unit (ICU)-LOS, cost of therapy, and total hospital cost.
Results:
Six hundred fifty-seven patients met inclusion criteria of whom 250 patients (4-PCC:125; 3-PCC:125) were matched. The mean age was 50 ± 19.4 y, 64% were male, and median-injury severity score was 24[15-33]. 4-PCC was associated with accelerated correction of INR (365 vs. 428 min, P = 0.01), decrease in red blood cells (7 units vs. 10 units, P = 0.04) and FFP (6 units vs. 8 units, 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 with 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.
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