Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients

Moustafa Younis, Mohamed Ray-Zack, Nadeem N. Haddad, Asad Choudhry, Matthew C. Hernandez, Kevin Wise, Martin D. Zielinski

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Coagulopathy can delay or complicate surgical diseases that require emergent surgical treatment. Prothrombin complex concentrates (PCC) provide concentrated coagulation factors which may reverse coagulopathy more quickly than plasma (FFP) alone. We aimed to determine the time to operative intervention in coagulopathic emergency general surgery patients receiving either PCC or FFP. We hypothesize that PCC administration more rapidly normalizes coagulopathy and that the time to operation is diminished compared to FFP alone. Methods: Single institution retrospective review was performed for coagulopathic EGS patients during 2/1/2008 to 8/1/2016. Patients were divided into three groups (1) PCC alone (2) FFP alone and (3) PCC and FFP. The primary outcome was the duration from clinical decision to operate to the time of incision. Summary and univariate analyses were performed. Results: Coagulopathic EGS patients (n = 183) received the following blood products: PCC (n = 20, 11%), FFP alone (n = 119, 65%) and PCC/FFP (n = 44, 24%). The mean (± SD) patient age was 71 ± 13 years; 60% were male. The median (IQR) Charlson comorbidity index was similar in all three groups (PCC = 5(4–6), FFP = 5(4–7), PCC/FFP = 5(4–6), p = 0.33). The mean (± SD) dose of PCC administered was similar in the PCC/FFP group and the PCC alone group (2539 ± 1454 units vs. 3232 ± 1684, p = .09). The mean (±SD) time to incision in the PCC alone group was significantly lower than the FFP alone group (6.0 ± 3.6 vs. 8.8 ± 5.0 h, p = 0.01). The mean time to incision in the PCC + FFP group was also significantly lower than the FFP alone group (7.1 ± 3.6 vs. 8.8 ± 5.0, p = 0.03). The incidence of thromboembolic complications was similar in all three groups. Conclusions: PCC, alone or in combination with FFP, reduced INR and time to surgery effectively and safely in coagulopathic EGS patients without an apparent increased risk of thromboembolic events, when compared to FFP use alone. Level of evidence: IV single institutional retrospective review.

Original languageEnglish (US)
Pages (from-to)2383-2391
Number of pages9
JournalWorld Journal of Surgery
Volume42
Issue number8
DOIs
StatePublished - Aug 1 2018
Externally publishedYes

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Emergencies
prothrombin complex concentrates
Blood Coagulation Factors
International Normalized Ratio
Operative Time
Comorbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Younis, M., Ray-Zack, M., Haddad, N. N., Choudhry, A., Hernandez, M. C., Wise, K., & Zielinski, M. D. (2018). Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients. World Journal of Surgery, 42(8), 2383-2391. https://doi.org/10.1007/s00268-018-4520-2

Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients. / Younis, Moustafa; Ray-Zack, Mohamed; Haddad, Nadeem N.; Choudhry, Asad; Hernandez, Matthew C.; Wise, Kevin; Zielinski, Martin D.

In: World Journal of Surgery, Vol. 42, No. 8, 01.08.2018, p. 2383-2391.

Research output: Contribution to journalArticle

Younis, M, Ray-Zack, M, Haddad, NN, Choudhry, A, Hernandez, MC, Wise, K & Zielinski, MD 2018, 'Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients', World Journal of Surgery, vol. 42, no. 8, pp. 2383-2391. https://doi.org/10.1007/s00268-018-4520-2
Younis, Moustafa ; Ray-Zack, Mohamed ; Haddad, Nadeem N. ; Choudhry, Asad ; Hernandez, Matthew C. ; Wise, Kevin ; Zielinski, Martin D. / Prothrombin Complex Concentrate Reversal of Coagulopathy in Emergency General Surgery Patients. In: World Journal of Surgery. 2018 ; Vol. 42, No. 8. pp. 2383-2391.
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abstract = "Background: Coagulopathy can delay or complicate surgical diseases that require emergent surgical treatment. Prothrombin complex concentrates (PCC) provide concentrated coagulation factors which may reverse coagulopathy more quickly than plasma (FFP) alone. We aimed to determine the time to operative intervention in coagulopathic emergency general surgery patients receiving either PCC or FFP. We hypothesize that PCC administration more rapidly normalizes coagulopathy and that the time to operation is diminished compared to FFP alone. Methods: Single institution retrospective review was performed for coagulopathic EGS patients during 2/1/2008 to 8/1/2016. Patients were divided into three groups (1) PCC alone (2) FFP alone and (3) PCC and FFP. The primary outcome was the duration from clinical decision to operate to the time of incision. Summary and univariate analyses were performed. Results: Coagulopathic EGS patients (n = 183) received the following blood products: PCC (n = 20, 11{\%}), FFP alone (n = 119, 65{\%}) and PCC/FFP (n = 44, 24{\%}). The mean (± SD) patient age was 71 ± 13 years; 60{\%} were male. The median (IQR) Charlson comorbidity index was similar in all three groups (PCC = 5(4–6), FFP = 5(4–7), PCC/FFP = 5(4–6), p = 0.33). The mean (± SD) dose of PCC administered was similar in the PCC/FFP group and the PCC alone group (2539 ± 1454 units vs. 3232 ± 1684, p = .09). The mean (±SD) time to incision in the PCC alone group was significantly lower than the FFP alone group (6.0 ± 3.6 vs. 8.8 ± 5.0 h, p = 0.01). The mean time to incision in the PCC + FFP group was also significantly lower than the FFP alone group (7.1 ± 3.6 vs. 8.8 ± 5.0, p = 0.03). The incidence of thromboembolic complications was similar in all three groups. Conclusions: PCC, alone or in combination with FFP, reduced INR and time to surgery effectively and safely in coagulopathic EGS patients without an apparent increased risk of thromboembolic events, when compared to FFP use alone. Level of evidence: IV single institutional retrospective review.",
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AU - Younis, Moustafa

AU - Ray-Zack, Mohamed

AU - Haddad, Nadeem N.

AU - Choudhry, Asad

AU - Hernandez, Matthew C.

AU - Wise, Kevin

AU - Zielinski, Martin D.

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N2 - Background: Coagulopathy can delay or complicate surgical diseases that require emergent surgical treatment. Prothrombin complex concentrates (PCC) provide concentrated coagulation factors which may reverse coagulopathy more quickly than plasma (FFP) alone. We aimed to determine the time to operative intervention in coagulopathic emergency general surgery patients receiving either PCC or FFP. We hypothesize that PCC administration more rapidly normalizes coagulopathy and that the time to operation is diminished compared to FFP alone. Methods: Single institution retrospective review was performed for coagulopathic EGS patients during 2/1/2008 to 8/1/2016. Patients were divided into three groups (1) PCC alone (2) FFP alone and (3) PCC and FFP. The primary outcome was the duration from clinical decision to operate to the time of incision. Summary and univariate analyses were performed. Results: Coagulopathic EGS patients (n = 183) received the following blood products: PCC (n = 20, 11%), FFP alone (n = 119, 65%) and PCC/FFP (n = 44, 24%). The mean (± SD) patient age was 71 ± 13 years; 60% were male. The median (IQR) Charlson comorbidity index was similar in all three groups (PCC = 5(4–6), FFP = 5(4–7), PCC/FFP = 5(4–6), p = 0.33). The mean (± SD) dose of PCC administered was similar in the PCC/FFP group and the PCC alone group (2539 ± 1454 units vs. 3232 ± 1684, p = .09). The mean (±SD) time to incision in the PCC alone group was significantly lower than the FFP alone group (6.0 ± 3.6 vs. 8.8 ± 5.0 h, p = 0.01). The mean time to incision in the PCC + FFP group was also significantly lower than the FFP alone group (7.1 ± 3.6 vs. 8.8 ± 5.0, p = 0.03). The incidence of thromboembolic complications was similar in all three groups. Conclusions: PCC, alone or in combination with FFP, reduced INR and time to surgery effectively and safely in coagulopathic EGS patients without an apparent increased risk of thromboembolic events, when compared to FFP use alone. Level of evidence: IV single institutional retrospective review.

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