Joseph Bellal, Aziz Hassan, Pandit Viraj, Hays Daniel, Kulvatunyou Narong, Yousuf Zeeshan, Tang Andrew, O'Keeffe Terence, Green Donald, Friese Randall S, Rhee Peter
Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Avenue, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, US,
World J Surg. 2014 Aug;38(8):1875-81. doi: 10.1007/s00268-014-2631-y.
The development of coagulopathy of trauma is multifactorial associated with hypoperfusion and consumption of coagulation factors. Previous studies have compared the role of factor replacement versus FPP for reversal of trauma coagulopathy. The purpose of our study was to determine the time to correction of coagulopathy and blood product requirement in patients who received PCC+FFP compared with patients who received FFP alone.
We performed a retrospective analysis of a prospectively maintained database of all coagulopathic (INR ≥ 1.5) trauma patients presenting to our level I trauma center during a 2-years period (2011-2012). Patients were stratified into two groups: patients who received PCC+FFP and patients who received FFP alone. Patients in the two groups were matched in a 1:3 (PCC+FFP:FFP) ratio using propensity score matching for demographics, injury severity, vital parameters, and initial INR. The two groups were then compared for: correction of INR, time to correction of INR, thromboembolic complications, mortality, and cost of therapy.
A total of 252 were included in the analysis [PCC+FFP:63; FFP:189]. The mean age was 44 ± 20 years; 70 % were male, with a median ISS score of 27 [16-38]. PCC use was associated with an accelerated correction of INR (394 vs. 1,050 min; p 0.001), reduction in requirement of pack red blood cell (6.6 vs. 10 units; p 0.001) and FFP (2.8 vs. 3.9 units; p 0.01), and decline in mortality (23 vs. 28%; p 0.04). PCC+FFP use was associated with a higher cost of therapy ($1,470 ± 845 vs. 1,171 ± 949; p 0.01) but lower overall cost of transfusion ($7,110 ± 1,068 vs. 9,571 ± 1,524; p 0.01) compared with FFP therapy alone.
PCC in conjunction with FFP rapidly corrects INR in a matched cohort of trauma patients not on warfarin therapy compared with FFP therapy alone. The use of PCC as an adjunct to FFP therapy is associated with reduction of blood product requirement and also lowers overall cost.
创伤性凝血病的发生是多因素的，与低灌注及凝血因子消耗有关。既往研究比较了因子替代与新鲜冰冻血浆（FPP）在逆转创伤性凝血病中的作用。我们研究的目的是确定接受凝血酶原复合物（PCC）+新鲜冰冻血浆（FFP）的患者与仅接受FFP的患者相比，纠正凝血病的时间及血液制品需求量。
我们对一个前瞻性维护的数据库进行回顾性分析，该数据库包含2011年至2012年期间在我们的一级创伤中心就诊的所有凝血病（国际标准化比值[INR]≥1.5）创伤患者。患者被分为两组：接受PCC+FFP的患者和仅接受FFP的患者。使用倾向评分匹配法，按照1:3（PCC+FFP:FFP）的比例，对两组患者的人口统计学特征、损伤严重程度、生命体征参数及初始INR进行匹配。然后比较两组患者的INR纠正情况、INR纠正时间、血栓栓塞并发症、死亡率及治疗费用。
共有252例患者纳入分析[PCC+FFP组：63例；FFP组：189例]。平均年龄为44±20岁；70%为男性，损伤严重度评分（ISS）中位数为27[16 - 38]。使用PCC与INR的加速纠正相关（394分钟对1050分钟；p<0.001），浓缩红细胞需求量减少（6.6单位对10单位；p<0.001），FFP需求量减少（2.8单位对3.9单位；p<0.01），死亡率下降（23%对28%；p<0.04）。与仅接受FFP治疗相比，使用PCC+FFP治疗费用更高（1470±845美元对1171±949美元；p<0.01），但输血总费用更低（7110±1068美元对9571±1524美元；p<0.01）。
与仅接受FFP治疗相比，在未接受华法林治疗的创伤患者匹配队列中，PCC联合FFP能快速纠正INR。PCC作为FFP治疗的辅助手段与血液制品需求量减少相关，且降低了总体费用。
