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Prothrombin Complex Concentrate Utilization in Children's Hospitals
Jeffrey E Lutmer1, Christian Mpody2, Eric A Sribnick3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States.
Insights
Prothrombin complex concentrates (PCCs) use is rising in critically ill children, often for emergent reasons, not just anticoagulant reversal. Further research is needed on PCC indications, efficacy, and safety in pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Pharmacovigilance
Background:
- Prothrombin complex concentrates (PCCs) are crucial for managing bleeding in critically ill children.
- Understanding PCC utilization patterns and associated risk factors is essential for optimizing pediatric care.
Purpose of the Study:
- To describe the trends in PCC utilization in U.S. children's hospitals from 2015 to 2020.
- To determine the relationship between PCC use and specific bleeding risk factors, including anticoagulation and bleeding diatheses.
Main Methods:
- A repeat cross-sectional study using the Pediatric Health Information System (PHIS) registry.
- Inclusion of children under 18 years receiving 3-factor or 4-factor PCC between January 2015 and December 2020.
- Analysis of PCC therapy associations with anticoagulation and bleeding diatheses.
Main Results:
- PCC utilization increased steadily from 1.3 to 4.6 per 10,000 encounters over the 6-year period.
- Patients receiving PCC were critically ill (85.0% ICU admission) with a 25.8% mortality rate.
- PCCs were predominantly used emergently or urgently, more often in surgical than medical cases, and not strongly correlated with anticoagulant use.
Conclusions:
- PCC use in critically ill children is increasing and not solely for vitamin K antagonist reversal.
- Current PCC use patterns do not appear to correlate with specific anticoagulant therapies or identified bleeding risk factors.
- Further investigation into the indications, efficacy, and safety of PCC therapy in pediatric populations is warranted.
Abstract:
Prothrombin complex concentrates (PCCs) are used to manage bleeding in critically ill children. We performed a repeat cross-sectional study using the Pediatric Health Information System registry to describe PCC utilization in the U.S. children's hospitals over time and determine the relationship between PCC use and specific risk factors for bleeding. We included children < 18 years who received three-factor or four-factor PCC during hospital admission between January 2015 and December 2020 to describe the association between PCC therapy, anticoagulation therapies, and inherited or acquired bleeding diatheses. PCC use steadily increased over the 6-year study period (from 1.3 to 4.6 per 10,000 encounters). Patients exhibited a high degree of critical illness, with 85.0% requiring intensive care unit admission and a mortality rate of 25.8%. PCCs were used in a primarily emergent or urgent fashion (32.6 and 39.3%, respectively) and more frequently in surgical cases (79.0% surgical vs. 21.0% medical). Coding analysis suggested a low rate of chronic anticoagulant use which was supported by review of concomitant anticoagulant medications. PCC use is increasing in critically ill children and does not correlate with specific anticoagulant therapy use or other bleeding risk factors. These findings suggest PCC use is not limited to vitamin K antagonist reversal. Indications, efficacy, and safety of PCC therapy in children require further study.
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