Emergency Medicine · Vol. 5, No. 1 · 2019 · pp. 1–8 · e-ISSN 2379-4046

Prothrombin Complex Concentrates in Post-traumatic Hemorrhage: A Review

Ozgur Karcioglu, Ebru Yilmaz, Selman Yeniocak, Hakan Topacoglu

Department of Emergency Medicine, University of Health Sciences, Istanbul Education and Research Hospital, Istanbul,TurkeyTurkey
Department of Emergency Medicine, Nizip Community Hospital, Gaziantep,TurkeyTurkey
Department of Emergency Medicine, University of Health Sciences, Haseki Education and Research Hospital, Fatih, Istanbul,TurkeyTurkey
Department of Emergency Medicine, Duzce University, School of Medicine, Duzce,TurkeyTurkey

DOI: https://doi.org/10.17140/emoj-5-152 · Published 2019-08-30 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2019 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

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 deterio-ration induced by trauma, despite contradictory findings in the literature.

Keywords: Blood coagulation factor; Trauma; Hemorrhagic shock; Exsanguinating hemorrhage

Conclusion

PCC compounds has long been used to reverse coagulopathy following use of VKA. However, its use in TIC in patients not using VKA prescriptions has not been clarified. Some literature data yielded 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. PCC has practical and theoretical advantages to FFP, as it can be used more rapidly and it does not th prevention of thrombosis, 9 ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141: e152S-e184S. doi: 10.1378/chest.11-2295

9. Martin AC, Le Bonniec B, Fischer AM, et al. Evaluation of recombinant activated factor VII, prothrombin complex concentrate, and fibrinogen concentrate to reverse apixaban in a rabbit model of bleeding and thrombosis. Int J Cardiol. 2013; 168: 4228- 4233. doi: 10.1016/j.ijcard.2013.07.152

10. Marlu R, Hodaj E, Paris A, Albaladejo P, Crackowski JL, Pernod G. Effect of non-specific reversal agents on anticoagulant

activity of dabigatran and rivaroxaban: A randomized crossover ex-vivo study in healthy volunteers. Thromb Haemost. 2012; 108: 217-247. doi: 10.1160/TH12-03-0179

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12. Spahn DR, Bouillon B, Cerny V, et al. Management of bleeding and coagulopathy following major trauma: An updated European guideline. Crit Care. 2013; 17(2): R76. doi: 10.1186/cc12685

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