Prothrombin Complex Concentrate to Treat Coagulation Disturbances in Pediatric Patients With Intracranial Pathology Including Traumatic Brain Injury

Abstract

Background: Coagulation disturbances and hemorrhage are common in critically ill pediatric patients especially those with intracranial pathology or traumatic brain injury (TBI). Even with therapy directed by laboratory parameters, blood products may fail to effectively correct the underlying coagulation defect. To mitigate these challenges, various adjunctive agents including prothrombin complex concentrates (PCCs) have been used in patients who have coagulation disturbances refractory to standard therapy. However, data regarding the use of PCCs in pediatric-aged patients are limited. Methods and Results:We retrospectively identified 47 critically ill pediatric patients, ranging in age from 1 day to 18 years, with intracranial pathology including TBI who received PCC. The primary clinical indications for four-factor PCC (4F-PCC) were surgical procedures, hemorrhage control, or intracranial pressure monitor placement. A total of 71 doses of 4F-PCC were administered to the 47 patients in the study cohort. The PCC dose ranged from 11 to 75 units/kg (median dose 26 units/kg). The majority of patients (n = 35, 75%) received one dose of 4F-PCC while 12 patients received more than one dose. Following the administration of PCC, there was a correction in laboratory assessment of coagulation function (international normalized ratio and prothrombin time) with a limited effect on partial thromboplastin time. Because of the severity of illness and limitations of controlling confounding variables in a retrospective study, additional information on the direct effects of 4F-PCC on patient outcome including blood product utilization was limited. Conclusions:Given the increasing use of PCC in pediatric-aged patients and its potential utility in life-threatening scenarios, additional clinical trials are needed to define clinical indications, dosing regimens, and optimal monitoring techniques.