• Louanne M Carabini, Ashley N Budd, Patricia Bochey, Shahriar Shayan, Glenn Ramsey, and Robert J McCarthy.
• Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America. Electronic address: Louanne.Carabini@NM.org.
• J Clin Anesth. 2021 Jun 1; 70: 110164.

Study ObjectiveExplore how the introduction of 4-factor prothrombin complex concentrates (4F-PCC) protocols for reversing anticoagulation and the treatment of critical bleeding influenced blood product utilization.DesignA retrospective analysis of the utilization rate of plasma and 4F-PCC from September 2012 through December 2018.SettingBlood bank and pharmacy records of a single large tertiary care medical center.PatientsAdmitted patients except obstetric during the study period (n = 283,319).InterventionFive institutional protocols providing guidelines for 4F-PCC administration were deployed over a 3-year period.MeasurementsThe utilization rate of plasma and 4F-PCC was the primary outcome and analyzed using an interrupted time series analysis. Utilization of platelets and cryoprecipitate as well as the impact of the intervention on the service prescribing the blood products were evaluated as secondary outcomes. Data were evaluated using a segmented time series regression.ResultsWhen adjusted for seasonality, the monthly rate of plasma administration was 24.7 ± 2.0 units per 100 admissions in the 6-month period prior to the 1st intervention (May-October 2013) and decreased to 9.9 ± 2.2 units per 100 admissions in the same six-month period following the 5th intervention (May-October 2018), median difference - 14.5, 95% CI -16.0 to -13.2, P < 0.001. During the 6-month period prior to the 1st intervention (May-October 2013) the monthly rate of 4-F PCC use was 1.2 ± 0.8 doses per 1000 admissions and increased to 2.8 ± 1.0 doses per 1000 admissions 6-months following the 5th intervention (May-October 2018), median difference 1.6, 95% CI 0.3 to 1.9, P = 0.014. The monthly utilization of platelets was decreased and cryoprecipitate slightly increased following the implementation of the PCC protocols.Conclusions And RelevanceOur findings demonstrate that establishing institutional protocols for the use of 4F-PCC to reverse the effects of anticoagulation and to treat critical bleeding with associated coagulopathy was associated with reduced plasma utilization.Copyright © 2021 Elsevier Inc. All rights reserved.

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