Drebes Anja, de Vos Marie, Gill Sunita, Fosbury Emma, Mallett Sue, Burroughs Andy, Agarwal Banwari, Patch David, Chowdary Pratima
Katharine Dormandy Haemophilia and Thrombosis Centre Royal Free Hospital London United Kingdom.
UCL Institute for Liver Disease and Digestive Health Royal Free Hospital and UCL London United Kingdom.
Hepatol Commun. 2019 Feb 5;3(4):513-524. doi: 10.1002/hep4.1293. eCollection 2019 Apr.
Patients with liver disease frequently develop coagulopathy, and fresh frozen plasma is traditionally used for correction of coagulopathy to manage and prevent bleeding. Prothrombin complex concentrates (PCCs) offer an attractive alternative because they are more readily available and avoid large-volume transfusion. This retrospective, single-center study reviewed clinical use of PCC in patients with acute/chronic liver disease. A total of 105 patients with 194 episodes of PCC administration were reviewed. Data pertaining to indication, dosing, effectiveness, and safety were collected. The effect of PCC on coagulation was analyzed in patients for whom coagulation results were available 7 hours before and after PCC. Data on thromboembolic events and mortality within 4 weeks of PCC administration were captured. Most patients (77%) had chronic liver disease; the remainder had acute liver failure. Indications for PCC were preprocedure prophylaxis and treatment for active/recent bleeding in 48% and 52% of 194 treatment episodes, respectively. The median dose of PCC administered was 22 IU/kg (interquartile range, 16-29 IU/kg). Before PCC administration, 45% of patients had an international normalized ratio (INR) greater than 2.0, and 36% had fibrinogen levels of at least 1.5 g/L. PCC produced statistically significant reductions in prothrombin time and INR (coadministration with fibrinogen or cryoprecipitate: 3.1 versus 1.9; < 0.001; no coadministration: 2.3 versus 1.8; < 0.001). Three patients with multiple risk factors developed thrombotic events (hepatic artery thrombosis, incidental bilateral pulmonary embolism, nonocclusive portal vein thrombosis); there were no cardiovascular or cerebrovascular adverse events. Overall, 46 patients died of causes unrelated to PCC treatment. In patients with liver disease, PCC therapy was effective in improving coagulation test results without an excess of thrombotic events. Further assessment of PCC as hemostatic therapy in this setting is required.
肝病患者常出现凝血功能障碍，传统上使用新鲜冰冻血浆来纠正凝血功能障碍以管理和预防出血。凝血酶原复合物浓缩剂（PCCs）是一种有吸引力的替代选择，因为它们更容易获得且可避免大量输血。这项回顾性单中心研究评估了PCC在急性/慢性肝病患者中的临床应用。共回顾了105例患者的194次PCC给药情况。收集了有关适应证、剂量、有效性和安全性的数据。对PCC给药前后7小时有凝血结果的患者分析了PCC对凝血的影响。记录了PCC给药后4周内的血栓栓塞事件和死亡率数据。大多数患者（77%）患有慢性肝病；其余患者患有急性肝衰竭。PCC的适应证在194次治疗中分别有48%用于术前预防和52%用于治疗活动性/近期出血。PCC的中位给药剂量为22 IU/kg（四分位间距，16 - 29 IU/kg）。在给予PCC之前，45%的患者国际标准化比值（INR）大于2.0，36%的患者纤维蛋白原水平至少为1.5 g/L。PCC使凝血酶原时间和INR有统计学意义的降低（与纤维蛋白原或冷沉淀联合使用：3.1对1.9；<0.001；未联合使用：2.3对1.8；<0.001）。3例具有多种危险因素的患者发生了血栓事件（肝动脉血栓形成、偶发性双侧肺栓塞、非闭塞性门静脉血栓形成）；无心血管或脑血管不良事件。总体而言，46例患者死于与PCC治疗无关的原因。在肝病患者中，PCC治疗可有效改善凝血试验结果，且无过多血栓事件。需要进一步评估PCC在这种情况下作为止血治疗的效果。
