Prothrombin Complex Concentrates in Post-traumatic Hemorrhage: A Review

Abstract

Prothrombin complex concentrates (PCC) has long been used to reverse vitamin K antagonists (VKA)-induced coagulopathy rapidly and safely. However, its use in trauma-induced coagulopathy (TIC) in patients not using VKA drugs is yet to be elucidated. This article is a narrative review and analysis of the most recent literature to analyse consequences, and intended effects associated with this treatment modality in TIC. Utilization of PCC was addressed in the literature data found by searches of databases. The indications, efficacy and outcomes associated with the use of the product were reviewed in the articles. Some studies point out promising results with respect to PCC use to overcome the VKA-related coagulopathy in victims of trauma. PCC may be a viable option for resuscitation in emergency and critical care in the management of severe hemodynamic deterioration induced by trauma, despite contradictory findings in the literature.

Management of Complex Upper Extremity Trauma with Associated Vascular Injury

“…This helps in assessing the condition of the muscles before and after revascularization and acts as prophylaxis against compartment syndrome developing after revascularization. 18 The problems that can happen with missed compartment syndrome are much worse than that of a negative fasciotomy. 10 13 19…”

Alternative blood products in trauma

“…For warfarin-associated bleeding, rates of thromboembolic events with PCC in addition to FFP have been shown to be comparable to those of FFP alone, but PCC alone compared to FFP has a higher incidence of thromboembolic events at 30 days, especially in patients with a prior history of clotting [23 & ]. Of note, four factor PCC (which contains more factor VII in addition to proteins C, S, antithrombin, and heparin) [21] has been shown to be superior to three factor PCC in decreasing the incidence of thromboembolic events [22], correcting the INR more quickly, decreasing the number of transfused products, and decreasing overall cost [24].…”

“…Although PCC costs more than FFP, it effectively reduces the amount of pRBCs needed, offsetting overall costs [21]. It is invaluable in head trauma and can also expeditiously reverse effects of dual oral anticoagulation agents (DOACs) such as apixaban and rivaroxaban [22]. Although PCC should be considered in trauma for use as an alternative or in conjunction with FFP, clinicians should be aware of its thromboembolic risk and ask patients about prior clot history.…”