Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients

Bellal A Joseph, Viraj Pandit, Mazhar Khalil, Narong Kulvatunyou, Hassan Aziz, Andrew - Tang, Terence S Okeeffe, Daniel Hays, Lynn Gries, Gerald M Lemole, Randall S Friese, Peter M Rhee

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)601-607
Number of pages7
JournalNeurosurgery
Volume76
Issue number5
DOIs
StatePublished - May 21 2015

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Craniotomy
International Normalized Ratio
Warfarin
Glasgow Coma Scale
Therapeutics
Traumatic Brain Injury
prothrombin complex concentrates
Abbreviated Injury Scale
Outcome Assessment (Health Care)
Propensity Score
Injury Severity Score
Trauma Centers
Sex Ratio
Craniocerebral Trauma
Erythrocytes

Keywords

  • Fresh frozen plasma
  • Prothrombin complex concentrate
  • Time to craniotomy
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients. / Joseph, Bellal A; Pandit, Viraj; Khalil, Mazhar; Kulvatunyou, Narong; Aziz, Hassan; Tang, Andrew -; Okeeffe, Terence S; Hays, Daniel; Gries, Lynn; Lemole, Gerald M; Friese, Randall S; Rhee, Peter M.

In: Neurosurgery, Vol. 76, No. 5, 21.05.2015, p. 601-607.

Research output: Contribution to journalArticle

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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.",
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AU - Joseph, Bellal A

AU - Pandit, Viraj

AU - Khalil, Mazhar

AU - Kulvatunyou, Narong

AU - Aziz, Hassan

AU - Tang, Andrew -

AU - Okeeffe, Terence S

AU - Hays, Daniel

AU - Gries, Lynn

AU - Lemole, Gerald M

AU - Friese, Randall S

AU - Rhee, Peter M

PY - 2015/5/21

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N2 - 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.

AB - 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.

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KW - Prothrombin complex concentrate

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KW - Traumatic brain injury

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