Department of Surgery, University of Arizona, College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85727-5063, USA.
J Trauma Acute Care Surg. 2012 Apr;72(4):828-34. doi: 10.1097/TA.0b013e318247c944.
Damage control resuscitation advocates correction of coagulopathy; however, options are limited and expensive. The use of prothrombin complex concentrate (PCC), also known as factor IX complex, can quickly accelerate reversal of coagulopathy at relatively low cost. The purpose of this study is to describe our experience in the use of factor IX complex in coagulopathic trauma patients.
All patients receiving PCC at our Level I trauma center over a two-year period (2008-2010) were reviewed. PCC was used at the discretion of the trauma attending for treatment of coagulopathy, reversal of coumadin, and when recombinant factor VIIa was indicated.
Forty-five trauma patients received 51 doses of PCC. Sixty-two per cent were male and mean Injury Severity Score was 23 (± 14.87). Standard dose was 25 units per kg and mean cost per patient was $1,022 ($504-3,484). Fifty-eight per cent of patients were on warfarin before admission. Mean international normalized ratio (INR) was decreased after PCC administration (p = 0.001). Packed red blood cell transfusion was also reduced after factor IX complex (p = 0.018). Mean INR was reduced in both the nonwarfarin (p = 0.001) and warfarin (p = 0.001) groups. Packed red blood cell transfusion was less in the nonwarfarin group (p = 0.002) however was not significant in the warfarin group. Subsequent thromboembolic events were observed in 3 of the 45 patients (7%). Mortality was 16 of 45 (36%).
PCC rapidly and effectively treats coagulopathy after traumatic injury. PCC therapy leads to a significant correction in INR in all trauma patients, regardless of coumadin use, and concomitant reduction in blood product transfusion. PCC should be considered as an effective tool to treat acute coagulopathy of trauma. Further prospective studies examining the safety, efficacy, cost, and outcomes comparing PCC and recombinant factor VIIa are needed.
损伤控制性复苏提倡纠正凝血功能障碍；然而，选择有限且昂贵。使用凝血酶原复合物浓缩物（PCC），也称为因子 IX 复合物，可以快速、低成本地加速凝血功能障碍的逆转。本研究的目的是描述我们在凝血功能障碍性创伤患者中使用因子 IX 复合物的经验。
回顾了在我们的一级创伤中心两年期间（2008-2010 年）接受 PCC 治疗的所有患者。PCC 由创伤主治医生根据治疗凝血功能障碍、逆转华法林和使用重组因子 VIIa 的需要使用。
45 例创伤患者接受了 51 剂 PCC。62%为男性，平均损伤严重程度评分 23（±14.87）。标准剂量为 25 单位/公斤，每位患者的平均费用为 1022 美元（504-3484 美元）。58%的患者在入院前服用华法林。PCC 给药后平均国际标准化比值（INR）降低（p = 0.001）。因子 IX 复合物后也减少了红细胞悬液的输注（p = 0.018）。非华法林组（p = 0.001）和华法林组（p = 0.001）的 INR 均降低。红细胞悬液输注量在非华法林组减少（p = 0.002），但在华法林组不显著。45 例患者中有 3 例（7%）观察到随后的血栓栓塞事件。45 例患者中有 16 例（36%）死亡。
PCC 可快速有效地治疗创伤后凝血功能障碍。PCC 治疗可使所有创伤患者的 INR 显著纠正，无论华法林的使用情况如何，同时减少血液制品的输注。PCC 应被视为治疗急性创伤性凝血功能障碍的有效工具。需要进一步进行前瞻性研究，以检查 PCC 和重组因子 VIIa 的安全性、有效性、成本和结果比较。
