Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan.
Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, Michigan, USA,
Eur Surg Res. 2020;61(2-3):51-61. doi: 10.1159/000509876. Epub 2020 Sep 23.
Damage control resuscitation forms the cornerstone of management in trauma surgery. Several blood products have been widely used for preoperative transfusions prior to emergency surgeries and for hemorrhage control in trauma. Prothrombin complex concentrate (PCC) is now being introduced as an essential component of damage control resuscitation.
We did a comparative descriptive analysis of several single and multi-institutional clinical trials and retrospective cohort studies. The primary focus of these studies was a comparison between PCC and other transfusion modalities including recombinant factor VIIa, fresh-frozen plasma, and fibrinogen based on several vital parameters. The parameters included rapid international normalized ratio reversal, hospital length of stay, cost-effectiveness, mortality rate, and rate of thromboembolic complications.
Although still awaiting its approval from the FDA for use in traumatic coagulopathy, 4-factor PCC has shown far more convincing results in contrast to former transfusion modalities, even 3-factor PCC. However, more prospective extensive clinical trials on national levels are needed to compare its effectiveness to 3-factor PCC and gather promising recognition in the trauma care fraternity.
损伤控制性复苏是创伤外科治疗的基石。在紧急手术前和创伤出血控制中，已经广泛使用了几种血液制品进行术前输血。凝血酶原复合物浓缩物（PCC）现在被引入作为损伤控制性复苏的重要组成部分。
我们对几项单中心和多中心临床试验和回顾性队列研究进行了比较描述性分析。这些研究的主要重点是比较 PCC 与其他输血方式，包括重组因子 VIIa、新鲜冷冻血浆和纤维蛋白原，基于几个重要参数。这些参数包括快速国际标准化比值逆转、住院时间、成本效益、死亡率和血栓栓塞并发症发生率。
尽管 PCC 仍在等待 FDA 批准用于创伤性凝血病，但与以前的输血方式相比，4 因子 PCC 显示出更有说服力的结果，甚至 3 因子 PCC 也是如此。然而，需要在国家层面进行更多的前瞻性广泛临床试验，以比较其与 3 因子 PCC 的有效性，并在创伤护理界获得有希望的认可。
