华法林治疗的创伤患者 INR 逆转时使用凝血酶原复合物浓缩物与标准治疗的比较。
Prothrombin complex concentrate versus standard therapies for INR reversal in trauma patients receiving warfarin.
机构信息
Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.
出版信息
Ann Pharmacother. 2011 Jul;45(7-8):869-75. doi: 10.1345/aph.1P605. Epub 2011 Jul 20.
BACKGROUND
Prothrombin complex concentrate (PCC) is recommended as a therapy to be considered for the reversal of warfarin's effects. Few published data are available on the use of PCC for this indication in traumatically injured patients.
OBJECTIVE
To determine whether the addition of PCC to standard approaches to warfarin reversal more rapidly corrects the international normalized ratio (INR) in injured patients.
METHODS
A retrospective analysis was performed in trauma patients who were on warfarin preinjury from January 2007 to September 2009 at North Memorial Medical Center. Data were collected from medical records and the trauma registry. Patients were separated based on whether or not they received PCC. The groups were compared on the basis of demographics, units of fresh frozen plasma (FFP), vitamin K use, units of PCC, number of patients achieving an INR of 1.5 or less, time to an INR of 1.5 or less, mortality, intensive care unit (ICU) and hospital length of stay, and the incidence of thromboembolic events during hospitalization.
RESULTS
Thirty-one patients were included in the analysis; 13 patients who received a total mean (SD) dose of 2281 (1053) units (25.6 [12.2] units/kg) of PCC (Profilnine SD) were compared to 18 patients who did not receive PCC. There was no significant difference between groups in FFP units received or the number of patients who received vitamin K. Most patients in both groups achieved an INR of 1.5 or less (92% PCC vs 89% no PCC). However, the mean time to achieve an INR of 1.5 or less was 16:59 (20:53) hours in the PCC group versus 30:03 (23:10) hours in the no PCC group (p = 0.048). There were 3 deaths in the PCC group and no deaths in the no PCC group (p = 0.06). ICU and hospital length of stay and number of thromboembolic events did not differ significantly between the 2 groups.
CONCLUSIONS
PCC, when added to FFP and vitamin K, resulted in a more rapid time to reversal of the INR.
背景
凝血酶原复合物浓缩物（PCC）被推荐作为逆转华法林作用的治疗方法。关于创伤患者中 PCC 用于该指征的使用，发表的数据很少。
目的
确定在创伤患者中，与标准华法林逆转方法相比，添加 PCC 是否能更快地纠正国际标准化比值（INR）。
方法
对 2007 年 1 月至 2009 年 9 月期间在北纪念医疗中心接受华法林治疗的创伤患者进行了回顾性分析。数据从病历和创伤登记处收集。根据是否接受 PCC 将患者分为两组。比较两组患者的人口统计学特征、新鲜冷冻血浆（FFP）单位数、维生素 K 使用情况、PCC 单位数、达到 INR 小于等于 1.5 的患者数量、达到 INR 小于等于 1.5 的时间、死亡率、重症监护病房（ICU）和住院时间以及住院期间血栓栓塞事件的发生率。
结果
分析纳入 31 例患者；其中 13 例患者接受了平均（标准差）剂量 2281（1053）单位（25.6 [12.2]单位/公斤）的 PCC（Profilnine SD），与未接受 PCC 的 18 例患者进行比较。两组之间接受的 FFP 单位数或接受维生素 K 的患者数没有显著差异。两组中大多数患者的 INR 均达到 1.5 或更低（PCC 组为 92%，无 PCC 组为 89%）。然而，达到 INR 1.5 或更低的平均时间在 PCC 组为 16:59（20:53）小时，在无 PCC 组为 30:03（23:10）小时（p=0.048）。PCC 组有 3 例死亡，无 PCC 组无死亡（p=0.06）。两组 ICU 和住院时间以及血栓栓塞事件的数量没有显著差异。
结论
当与 FFP 和维生素 K 一起添加 PCC 时，INR 的逆转时间更快。
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