Paisley Michael John, Johnson Arianne, Price Spencer, Chow Bernard, Limon Liliana, Sharma Rohit, Kaminski Stephen
Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
Trauma, Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
Trauma Surg Acute Care Open. 2019 Dec 15;4(1):e000352. doi: 10.1136/tsaco-2019-000352. eCollection 2019.
The efficacy of prothrombin complex concentrate (PCC) compared with fresh frozen plasma (FFP) for reversal of oral anticoagulants has not been investigated in geriatric patients suffering intracranial hemorrhage (ICH) due to a ground-level fall (GLF).
Patients 65 years and older who were treated at Santa Barbara Cottage Hospital between January 2011 and March 2018 with ICH after a GLF while taking warfarin were reviewed. Patients were reversed with either FFP (n=25) or PCC (n=27) and patient outcomes were compared. Separate analyses were conducted for patients who received adjuvant vitamin K administration and those who did not.
Mortality rates, hospital length of stay, intensive care unit admission and length of stay were similar for both FFP and PCC intervention. There was no difference in radiological progression of hemorrhage within the first 24 hours of admission (FFP: 36%, PCC: 43%, p=0.365). In patients who had international normalized ratio (INR) values measured prior to intervention, 81% (17 out of 21) of the PCC group reached an INR value below 1.5 within an 8-hour period, whereas only 29% (4 out of 14) of the FFP group did (p=0.002). Vitamin K was concomitantly given to 28% of the patients receiving FFP, and 81% of those patients receiving PCC. No significant differences in outcomes were found whether adjunctive vitamin K was administered or not, in either FFP or PCC group. However, when vitamin K was not administered, the PCC group had a higher rate of INR reversal (80% vs. 10% for FFP, p=0.006).
Administration of PCC is as effective in short-term outcomes as FFP in treating geriatric patients on warfarin sustaining an ICH after a GLF. INR reversal was more successful, significantly faster, and required lower infusion volumes in patients receiving PCC.
Level III.
对于因平地跌倒（GLF）而发生颅内出血（ICH）的老年患者，与新鲜冰冻血浆（FFP）相比，凝血酶原复合物浓缩剂（PCC）用于逆转口服抗凝剂的疗效尚未得到研究。
回顾了2011年1月至2018年3月期间在圣巴巴拉小屋医院接受治疗的65岁及以上因GLF而发生ICH且正在服用华法林的患者。患者分别接受FFP（n = 25）或PCC（n = 27）进行逆转，并比较患者的结局。对接受辅助维生素K治疗的患者和未接受辅助维生素K治疗的患者进行了单独分析。
FFP和PCC干预的死亡率、住院时间、重症监护病房入住率和住院时间相似。入院后24小时内出血的影像学进展无差异（FFP：36%，PCC：43%，p = 0.365）。在干预前测量国际标准化比值（INR）值的患者中，PCC组81%（21例中的17例）在8小时内INR值降至1.5以下，而FFP组仅29%（14例中的4例）做到了这一点（p = 0.002）。28%接受FFP的患者同时接受了维生素K治疗，接受PCC的患者中这一比例为81%。在FFP或PCC组中，无论是否给予辅助维生素K，结局均无显著差异。然而，当未给予维生素K时，PCC组的INR逆转率更高（FFP为10%，PCC为80%，p = 0.006）。
在治疗因GLF而发生ICH且正在服用华法林的老年患者时，PCC在短期结局方面与FFP一样有效。接受PCC的患者INR逆转更成功，速度明显更快，且所需输注量更低。
三级。
