四因子凝血酶原复合物浓缩物与创伤相关出血患者的生存改善相关：一项全国范围的倾向评分匹配分析。
Four-factor prothrombin complex concentrate is associated with improved survival in trauma-related hemorrhage: A nationwide propensity-matched analysis.
机构信息
From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona (M.Z., M.H., L.G., F.J., A.N., T.O., N.K., B.J.); Division of Acute Care Surgery, Department of Surgery, University of Arizona College of Medicine, Phoenix, Arizona (A.J.F.); and Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland (J.S.).
出版信息
J Trauma Acute Care Surg. 2019 Aug;87(2):274-281. doi: 10.1097/TA.0000000000002262.
INTRODUCTION
Post-traumatic hemorrhage is the most common preventable cause of death in trauma. Numerous small single-center studies have shown the superiority of four-factor prothrombin complex concentrate (4-PCC) along with fresh frozen plasma (FFP) over FFP alone in resuscitation of trauma patients. The aim of our study was to evaluate outcomes of severely injured trauma patients who received 4-PCC + FFP compared to FPP alone.
METHODS
Two-year (2015-2016) analysis of the American College of Surgeons-Trauma Quality Improvement Program database. All adult (age ≥18 years) trauma patients who received 4-PCC + FFP or FFP alone were included. We excluded patients who were on preinjury anticoagulants. Patients were stratified into two groups: 4-PCC + FFP versus FFP alone and were matched in a 1:1 ratio using propensity score matching for demographics, vitals, injury parameters, comorbidities, and level of trauma centers. Outcome measures were packed red blood cells, plasma and platelets transfused, complications, and mortality.
RESULTS
A total of 468 patients (4-PCC + FFP, 234; FFP alone, 234) were matched. Mean age was 50 ± 21 years; 70% were males; median injury severity score was 27 [20-36], and 86% had blunt injuries. Four-PCC + FFP was associated with a decreased requirement for packed red blood cells (6 units vs. 10 units; p = 0.02) and FFP (3 units vs. 6 units; p = 0.01) transfusion compared to FFP alone. Patients who received 4-PCC + FFP had a lower mortality (17.5% vs. 27.7%, p = 0.01) and lower rates of acute respiratory distress syndrome (1.3% vs. 4.7%, p = 0.04) and acute kidney injury (2.1% vs. 7.3%, p = 0.01). There was no difference in the rates of deep venous thrombosis (p = 0.11) and pulmonary embolism (p = 0.33), adverse discharge disposition (p = 0.21), and platelets transfusion (p = 0.72) between the two groups.
CONCLUSIONS
Our study demonstrates that the use of 4-PCC as an adjunct to FFP is associated with improved survival and reduction in transfusion requirements compared to FFP alone in resuscitation of severely injured trauma patients. Further studies are required to evaluate the role of addition of PCC to the massive transfusion protocol.
LEVEL OF EVIDENCE
Therapeutic studies, level III.
简介
创伤后出血是创伤患者中最常见的可预防死亡原因。许多小型单中心研究表明，与单独使用新鲜冷冻血浆（FFP）相比，四因子凝血酶原复合物浓缩物（4-PCC）联合 FFP 在创伤患者复苏中具有优越性。我们的研究目的是评估接受 4-PCC+FFP 治疗的严重创伤患者与单独接受 FFP 治疗的患者的结局。
方法
对美国外科医师学会创伤质量改进计划数据库进行了为期两年（2015-2016 年）的分析。所有接受 4-PCC+FFP 或单独 FFP 治疗的成年（年龄≥18 岁）创伤患者均被纳入研究。我们排除了正在接受术前抗凝治疗的患者。患者分为两组：4-PCC+FFP 与单独 FFP，并使用倾向评分匹配在 1:1 的比例下进行匹配，以匹配人口统计学、生命体征、损伤参数、合并症和创伤中心的级别。观察指标为红细胞、血浆和血小板的输注量、并发症和死亡率。
结果
共匹配了 468 例患者（4-PCC+FFP，234 例；单独 FFP，234 例）。平均年龄为 50±21 岁；70%为男性；中位数损伤严重度评分 27[20-36]，86%为钝器伤。与单独使用 FFP 相比，4-PCC+FFP 可减少红细胞（6 单位 vs. 10 单位；p=0.02）和 FFP（3 单位 vs. 6 单位；p=0.01）的输注量。接受 4-PCC+FFP 的患者死亡率较低（17.5% vs. 27.7%，p=0.01），急性呼吸窘迫综合征（1.3% vs. 4.7%，p=0.04）和急性肾损伤（2.1% vs. 7.3%，p=0.01）发生率较低。两组深静脉血栓形成（p=0.11）和肺栓塞（p=0.33）、不良出院处理（p=0.21）和血小板输注（p=0.72）的发生率无差异。
结论
我们的研究表明，与单独使用 FFP 相比，在严重创伤患者的复苏中，使用 4-PCC 作为 FFP 的辅助治疗与生存率提高和输血需求减少有关。需要进一步研究来评估添加 PCC 对大量输血方案的作用。
证据水平
治疗性研究，III 级。
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