• Bellal Joseph, Mazhar Khalil, Caitlyn Harrison, Tianyi Swartz, Narong Kulvatunyou, Ansab A Haider, Tahereh O Jokar, David Burk, Ali Mahmoud, Rifat Latifi, and Peter Rhee.
• Division of Trauma, Critical Care, Burns and Emergency Surgery, Department of Surgery, University of Arizona, Tucson, AZ.
• J Orthop Trauma. 2016 Dec 1; 30 (12): 653-658.

ObjectivesProthrombin 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.DesignTwo-year retrospective analysis.SettingOur level I trauma center.Patients/ParticipantsAll 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 MeasurementsTime to correction of INR, time to intervention, development of thromboembolic complications, mortality, and cost of therapy.ResultsA 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).ConclusionsIn 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 EvidenceTherapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

34 keywords...

hide…