88.05 3-Factor vs. 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three

Posted on January 18, 2018

M. Zeeshan1, M. Hamidi1, T. O’Keeffe1, N. Kulvatunyou1, A. Tang1, E. Zakaria1, L. Gries1, A. Jain1, B. Joseph1  1University Of Arizona,Tucson, AZ, USA

Introduction:
Coagulopathy of trauma (COT) is common and highly lethal. Prothrombin complex concentrate (PCC) has been shown to be a useful adjunct for the correction of this coagulopathy. However, the difference in efficacy between 3-factor PCC (3-PCC) vs. 4-factor PCC (4-PCC) in correcting COT remains unclear. The aim of our study is to compare the efficacy of 3-PCC vs. 4-PCC in trauma patients.

Methods:
A 4 year (2013-2016) review of all trauma patients at our Level I trauma center who received 3-factor or 4-factor PCC. Patients were divided into two groups (4-PCC and 3-PCC) and were matched in a 1:2 ratio using propensity score matching for demographics, injury severity, admission vitals, pre-injury warfarin use and initial INR. Corrected INR was defined as INR ≤1.5 Outcome measures were time to correction of INR, pRBC & FFP units transfused, thromboembolic complications (DVT or mesenteric thrombosis), and mortality. Sub analysis was performed on induced coagulopathy (on oral anticoagulant) patients.

Results:
516 patients who received PCC were analyzed of which 210 patients (4-PCC, 70; 3-PCC, 140) were matched.  The mean age was 50 ± 17 years; 55 % were male, and median [IQR] ISS was 25 [14–36]. 4-factor PCC was associated with accelerated correction of INR (336.7 vs. 401 min; p=0.02), decrease in pRBC units (5.4 vs. 6.9 units; p 0.03) and FFP units (3.1 vs. 4.5 units; p 0.03) transfused. There was no difference in thromboembolic complications (1.7% vs. 2.5% p=0.51), and mortality rate (23% vs. 25%; p=0.56) between the two groups. On sub-analysis of patients on warfarin (n=42), 4-factor PCC use resulted in an accelerated correction of INR (357.7 vs. 455.3 min; p=0.01) and reduction in FFP units transfused (3.8 vs. 5.1 units; p= 0.03). However, there was no reduction in pRBC requirements (0.9 vs. 1.2 units; p= 0.56).

Conclusion:
4-factor PCC is more effective as compared to the 3-factor PCC in reversal of coagulopathy of trauma by rapidly reversing the INR and decreasing the transfusion requirements. 4-factor PCC should be considered as a preferred agent for rapid reversal of coagulopathy of trauma.