Department of Pharmaceutical Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O Box 84428, Riyadh, Saudi Arabia; Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, USA.
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, USA.
Am J Emerg Med. 2018 Dec;36(12):2182-2186. doi: 10.1016/j.ajem.2018.03.064. Epub 2018 Mar 24.
Prothrombin complex concentrate (PCC) is used as an alternative to fresh frozen plasma (FFP) for emergency bleeding. The primary objective of this study was to compare the time from order to start of administration between 3-factor PCC (PCC3), 4-factor (PCC4), and FFP in the emergency department (ED). The secondary objective was to evaluate the effect of an ED pharmacist on time to administration of PCCs.
This was a single center three-arm retrospective cohort study. Adult patients in the ED with bleeding were included. The primary outcome measure was the time from order to administration, which was compared between PCC3, PCC4, and FFP. The time from order to administration was also compared when the ED pharmacist was involved versus not involved in the care of patients receiving PCC.
There were 90 patients included in the study cohort (30 in each group). The median age was 69years (IQR 57-82years), and 57% (n=52) were male. The median time from order to administration was 36min (IQR 20-58min) for PCC3, 34min (IQR 18-48min) for PCC4, and 92min (IQR 63-133) for FFP (PCC3 versus PCC4, p=0.429; PCC3 versus FFP, p<0.001; PCC4 versus FFP, p<0.001). The median time from order to administration was significantly decreased when the ED pharmacist was involved (24min [IQR 15-35min] versus 42min [IQR 32-59min], p<0.001).
Time from order to administration is faster with PCC than FFP. ED pharmacist involvement decreases the time from order to administration of PCC.
凝血酶原复合物浓缩物（PCC）可替代新鲜冷冻血浆（FFP）用于紧急出血。本研究的主要目的是比较 3 因子 PCC（PCC3）、4 因子（PCC4）和 FFP 在急诊科（ED）开始给药的时间。次要目的是评估 ED 药师对 PCC 给药时间的影响。
这是一项单中心三臂回顾性队列研究。ED 中有出血的成年患者被纳入研究。主要观察指标是从医嘱到给药的时间，比较 PCC3、PCC4 和 FFP 之间的差异。当 ED 药师参与或不参与接受 PCC 治疗的患者的护理时，从医嘱到给药的时间也进行了比较。
研究队列共纳入 90 例患者（每组 30 例）。中位年龄为 69 岁（IQR 57-82 岁），57%（n=52）为男性。从医嘱到给药的中位时间为 PCC3 组 36 分钟（IQR 20-58 分钟），PCC4 组 34 分钟（IQR 18-48 分钟），FFP 组 92 分钟（IQR 63-133 分钟）（PCC3 与 PCC4 相比，p=0.429；PCC3 与 FFP 相比，p<0.001；PCC4 与 FFP 相比，p<0.001）。当 ED 药师参与时，从医嘱到给药的中位时间显著缩短（24 分钟[IQR 15-35 分钟]与 42 分钟[IQR 32-59 分钟]相比，p<0.001）。
与 FFP 相比，PCC 从医嘱到给药的时间更快。ED 药师的参与缩短了 PCC 的给药时间。
