Lutmer Jeffrey E, Mpody Christian, Sribnick Eric A, Karube Takaharu, Tobias Joseph D
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States.
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States.
J Pediatr Intensive Care. 2021 Jul 3;12(3):219-227. doi: 10.1055/s-0041-1731686. eCollection 2023 Sep.
Prothrombin complex concentrates (PCCs) are used to manage bleeding in critically ill children. We performed a repeat cross-sectional study using the Pediatric Health Information System registry to describe PCC utilization in the U.S. children's hospitals over time and determine the relationship between PCC use and specific risk factors for bleeding. We included children < 18 years who received three-factor or four-factor PCC during hospital admission between January 2015 and December 2020 to describe the association between PCC therapy, anticoagulation therapies, and inherited or acquired bleeding diatheses. PCC use steadily increased over the 6-year study period (from 1.3 to 4.6 per 10,000 encounters). Patients exhibited a high degree of critical illness, with 85.0% requiring intensive care unit admission and a mortality rate of 25.8%. PCCs were used in a primarily emergent or urgent fashion (32.6 and 39.3%, respectively) and more frequently in surgical cases (79.0% surgical vs. 21.0% medical). Coding analysis suggested a low rate of chronic anticoagulant use which was supported by review of concomitant anticoagulant medications. PCC use is increasing in critically ill children and does not correlate with specific anticoagulant therapy use or other bleeding risk factors. These findings suggest PCC use is not limited to vitamin K antagonist reversal. Indications, efficacy, and safety of PCC therapy in children require further study.
凝血酶原复合物浓缩剂（PCCs）用于治疗危重症儿童的出血。我们利用儿科健康信息系统登记处进行了一项重复横断面研究，以描述美国儿童医院随时间推移的PCC使用情况，并确定PCC使用与特定出血危险因素之间的关系。我们纳入了2015年1月至2020年12月住院期间接受三因子或四因子PCC的18岁以下儿童，以描述PCC治疗、抗凝治疗与遗传性或获得性出血性疾病之间的关联。在6年的研究期内，PCC的使用稳步增加（从每10000次就诊1.3次增至4.6次）。患者表现出高度的危重症，85.0%需要入住重症监护病房，死亡率为25.8%。PCC主要以紧急或加急方式使用（分别为32.6%和39.3%），在外科病例中使用更频繁（外科病例占79.0%，内科病例占21.0%）。编码分析表明慢性抗凝剂使用率较低，这一点得到了对同时使用的抗凝药物审查的支持。危重症儿童中PCC的使用正在增加，且与特定抗凝治疗的使用或其他出血危险因素无关。这些发现表明PCC的使用不限于维生素K拮抗剂的逆转。PCC治疗在儿童中的适应证、疗效和安全性需要进一步研究。
