Background Severe deficiency in blood clotting factors is a cause of massive haemorrhage whose management in emergency situations is the subject of debate.
Purpose A prospective, observational study, to ascertain how prothrombin complex concentrates (PCC) are used and their efficacy in patients with life-threatening haemorrhagic disorders (trauma and surgery), especially in patients with underlying disease states that limit the synthesis of blood clotting factors. To assess the adherence to the European guideline recommendations.
Materials and methods In a third-level hospital, patients with a documented life-threatening haemorrhage who received a PCC prescription were included in the protocol, over a period of 12 months. Demographic data, treatment indication, prothrombin time, haemoglobin and haematocrit before and after treatment; diagnosis on admission, PCC dose, current oral anticoagulant treatment (OAT) and treatment administering vitamin K, and FFP or other blood products were recorded.
Results 45 patients were treated with PCC and included in the analysis. Mean patient age was 59.64 years, 42.2% were women and 57.77% men. The average dose was 1604 IU, the global survival after seven days was 73.33% and 35.55% had concomitant treatment with fibrinogen.
11.11% of the patients had been treated with oral anticoagulants (OAT) prior to the emergency bleeding,
48.89% had polytraumatic wounds,
4.44% had thrombocytopenia secondary to hepatopathy,
0% had haemophilia,
75.55% had an active haemorrhage,
68.89% underwent surgery, when the PCC was administered.
Quick time (s) (% // INR):
Before Administration: 25.36s (70.49%, 2.02)
After Administration: 19.47s (81.97%, 1.57)
After Three Days: 17.53s (84.03%, 1.26)
After Seven Days: 19.01s (81.64%, 1.38)
Haemoglobin (g/dL) and haematocrit levels (%):
Before Administration: 10.5 g/dL/31.09%
After Administration: 10.33 g/dL/30.18%
After Three Days: 10.28 g/dL/31.09%
Conclusions Following PCC administration the coagulation parameters improved dramatically. However, according to the European Guidelines, there aren’t enough studies to support PCC use other than in haemophilia or for the rapid reversal of the effect of oral vitamin K antagonists.
No conflict of interest.
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