Prothrombin Complex Concentrate Utilization in Children's Hospitals

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.