The following is a summary of “Prothrombin complex concentrate (PCC) for treatment of trauma-induced coagulopathy: systematic review and meta-analyses,” published in the November 2023 issue of Critical Care by Hannadjas et al.
Prothrombin complex concentrate (PCC) is used to treat trauma-induced coagulopathy (TIC), but its efficacy, timing, and evidence of use in trauma patients with hemorrhage are unclear. Researchers performed a retrospective study to assess the efficacy, timing, and evidence for the use of PCC to treat TIC in trauma patients with hemorrhage.
The study searched the MEDLINE and EMBASE databases, along with clinicaltrials.gov, to find studies on the use of PCC in treating major trauma in adults. The included studies examined PCC independently or in combination with other treatments and focused on in-hospital mortality and venous thromboembolism as primary outcomes. Excluded were studies involving pediatric patients, those focused solely on traumatic brain injury (TBI), and studies that only included anticoagulated patients. They assessed the quality of evidence by evaluating the risk of bias in each study and using the Grading of Recommendations Assessment, Development, and Evaluation. Pooled effects of PCC use were reported using random-effects model meta-analyses.
After screening 1,745 reports and removing duplicates, they included nine observational studies and one randomized controlled trial (RCT) involving 1,150 patients who received 4-factor-PCC at a dose of 20–30U/Kg. Co-interventions in the observational studies included whole blood (n=1), fibrinogen concentrate (n=2), or fresh frozen plasma (n=4). The outcomes, including mortality and deep venous thrombosis (DVT), were inconsistently reported with varying measurement methods and time points. The pooled odds ratio for mortality in the eight observational studies was 0.97 [95% CI 0.56–1.69], and for DVT, it was 0.83 [95% CI 0.44–1.57] in five studies. When combining the observational studies and the RCT, the odds ratio for mortality was 0.94 [95% CI 0.60–1.45], and for DVT, it was 1.00 [95% CI 0.64–1.55].
The study found PCC did not reduce mortality in TIC patients, but thrombosis risk remains a concern.