Assessing the efficacy of prothrombin complex concentrate in multiply injured patients with high-energy pelvic and extremity fractures

Bellal A Joseph, Mazhar Khalil, Caitlyn Harrison, Tianyi Swartz, Narong Kulvatunyou, Ansab A. Haider, Tahereh O. Jokar, David Burk, Ali Mahmoud, Rifat - Latifi, Peter M Rhee

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives: Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients. Design: Two-year retrospective analysis. Setting: Our level I trauma center. Patients/Participants: All coagulopathic [International normalized ratio (INR) ≥1.5] trauma patients. Patients with femur, tibia, or pelvic fracture were included. Patients were divided into 2 groups: PCC (single dose) and fresh frozen plasma (FFP). Patients in the 2 groups were matched using propensity score matching. Main Outcome Measurements: Time to correction of INR, time to intervention, development of thromboembolic complications, mortality, and cost of therapy. Results: A total of 81 patients (PCC: 27, FFP: 54) were included. Patients who received PCC had faster correction of INR and shorter time to surgical intervention in comparison to patients who received FFP. PCC therapy was also associated with lower overall blood product requirement (P 0.02) and lower transfusion costs (P 0.0001). Conclusions: In a matched cohort of multiply injured patients with pelvic and/or lower extremity fractures, administration of a single dose of PCC significantly reduced the time to correction of INR and time to intervention compared with patients who received FFP therapy. This may allow orthopaedic surgeons to more safely proceed with early, definitive fixation strategies. Level of Evidence: Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)653-658
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume30
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Extremities
International Normalized Ratio
prothrombin complex concentrates
Lower Extremity
Costs and Cost Analysis
Propensity Score
Trauma Centers
Wounds and Injuries
Therapeutics
Tibia
Femur
Research Design
Mortality

Keywords

  • coagulopathy reversal
  • extremity fractures
  • PCC
  • prothrombin complex
  • traumatic coagulopathy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Assessing the efficacy of prothrombin complex concentrate in multiply injured patients with high-energy pelvic and extremity fractures. / Joseph, Bellal A; Khalil, Mazhar; Harrison, Caitlyn; Swartz, Tianyi; Kulvatunyou, Narong; Haider, Ansab A.; Jokar, Tahereh O.; Burk, David; Mahmoud, Ali; Latifi, Rifat -; Rhee, Peter M.

In: Journal of Orthopaedic Trauma, Vol. 30, No. 12, 01.12.2016, p. 653-658.

Research output: Contribution to journalArticle

Joseph, Bellal A ; Khalil, Mazhar ; Harrison, Caitlyn ; Swartz, Tianyi ; Kulvatunyou, Narong ; Haider, Ansab A. ; Jokar, Tahereh O. ; Burk, David ; Mahmoud, Ali ; Latifi, Rifat - ; Rhee, Peter M. / Assessing the efficacy of prothrombin complex concentrate in multiply injured patients with high-energy pelvic and extremity fractures. In: Journal of Orthopaedic Trauma. 2016 ; Vol. 30, No. 12. pp. 653-658.
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abstract = "Objectives: Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients. Design: Two-year retrospective analysis. Setting: Our level I trauma center. Patients/Participants: All coagulopathic [International normalized ratio (INR) ≥1.5] trauma patients. Patients with femur, tibia, or pelvic fracture were included. Patients were divided into 2 groups: PCC (single dose) and fresh frozen plasma (FFP). Patients in the 2 groups were matched using propensity score matching. Main Outcome Measurements: Time to correction of INR, time to intervention, development of thromboembolic complications, mortality, and cost of therapy. Results: A total of 81 patients (PCC: 27, FFP: 54) were included. Patients who received PCC had faster correction of INR and shorter time to surgical intervention in comparison to patients who received FFP. PCC therapy was also associated with lower overall blood product requirement (P 0.02) and lower transfusion costs (P 0.0001). Conclusions: In a matched cohort of multiply injured patients with pelvic and/or lower extremity fractures, administration of a single dose of PCC significantly reduced the time to correction of INR and time to intervention compared with patients who received FFP therapy. This may allow orthopaedic surgeons to more safely proceed with early, definitive fixation strategies. Level of Evidence: Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.",
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AU - Khalil, Mazhar

AU - Harrison, Caitlyn

AU - Swartz, Tianyi

AU - Kulvatunyou, Narong

AU - Haider, Ansab A.

AU - Jokar, Tahereh O.

AU - Burk, David

AU - Mahmoud, Ali

AU - Latifi, Rifat -

AU - Rhee, Peter M

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N2 - Objectives: Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients. Design: Two-year retrospective analysis. Setting: Our level I trauma center. Patients/Participants: All coagulopathic [International normalized ratio (INR) ≥1.5] trauma patients. Patients with femur, tibia, or pelvic fracture were included. Patients were divided into 2 groups: PCC (single dose) and fresh frozen plasma (FFP). Patients in the 2 groups were matched using propensity score matching. Main Outcome Measurements: Time to correction of INR, time to intervention, development of thromboembolic complications, mortality, and cost of therapy. Results: A total of 81 patients (PCC: 27, FFP: 54) were included. Patients who received PCC had faster correction of INR and shorter time to surgical intervention in comparison to patients who received FFP. PCC therapy was also associated with lower overall blood product requirement (P 0.02) and lower transfusion costs (P 0.0001). Conclusions: In a matched cohort of multiply injured patients with pelvic and/or lower extremity fractures, administration of a single dose of PCC significantly reduced the time to correction of INR and time to intervention compared with patients who received FFP therapy. This may allow orthopaedic surgeons to more safely proceed with early, definitive fixation strategies. Level of Evidence: Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

AB - Objectives: Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients. Design: Two-year retrospective analysis. Setting: Our level I trauma center. Patients/Participants: All coagulopathic [International normalized ratio (INR) ≥1.5] trauma patients. Patients with femur, tibia, or pelvic fracture were included. Patients were divided into 2 groups: PCC (single dose) and fresh frozen plasma (FFP). Patients in the 2 groups were matched using propensity score matching. Main Outcome Measurements: Time to correction of INR, time to intervention, development of thromboembolic complications, mortality, and cost of therapy. Results: A total of 81 patients (PCC: 27, FFP: 54) were included. Patients who received PCC had faster correction of INR and shorter time to surgical intervention in comparison to patients who received FFP. PCC therapy was also associated with lower overall blood product requirement (P 0.02) and lower transfusion costs (P 0.0001). Conclusions: In a matched cohort of multiply injured patients with pelvic and/or lower extremity fractures, administration of a single dose of PCC significantly reduced the time to correction of INR and time to intervention compared with patients who received FFP therapy. This may allow orthopaedic surgeons to more safely proceed with early, definitive fixation strategies. Level of Evidence: Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

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