W. Readdy2, I. Farooqi2, A. Rayner2, R. Gupta1, J. Hanna1 1Rutgers-Robert Wood Johnson Medical School,Division Of Acute Care Surgery,New Brunswick, NJ, USA 2Rutgers Robert Wood Johnson Medical School,New Brunswick, NJ, USA
Introduction:
Four Factor Prothrombin Complex Concentrate (4F-PCC) has become an accepted standard of care for reversal of pharmacologic coagulopathy in the setting of traumatic brain injury (TBI). However, the benefit with regard to morbidity and mortality remains unknown. We hypothesize that 4F-PCC use will result in improved outcomes when compared to fresh frozen plasma (FFP).
Methods:
A prospectively maintained database at a level one trauma center was queried for patients with acute mild or moderate TBI, an Injury Severity Score (ISS) < 25, with a therapeutic INR on pharmacologic anticoagulation who received either FFP or 4F-PCC between 2011 and 2016. A retrospective chart review was performed to identify admission characteristics, in-hospital interventions, and outcomes.
Results:
Twenty-one and thirty-three patients who met criteria were identified who received FFP or 4F-PCC respectively. Admission characteristics including age and ISS were similar between the groups. Furthermore, GCS, brain injury, and initial INR were similar between the groups as shown in Table 1. There was no significant difference in discharge GCS, morbidity or mortality between groups (13.17 ± 3.68 vs 13.05 ± 4.48, 42.4% vs 38.1%, 21.2% vs. 14.3%, 4F-PCC vs FFP respectively), although time to reversal was shorter (360min vs 1737min, p<0.0001). Cost for pharmacologic therapy was significantly higher in the 4F-PCC cohort ($5493 vs $313, p<0.0001).
Conclusion:
4F-PCC has become the preferred method for rapid reversal of coagulopathy in TBI in many centers. However, these data suggest that despite a significant increase in cost, no clear benefit is evident with regard to discharge GCS, morbidity or mortality in mild to moderate TBI. We hypothesize that while emergent initiation of reversal is important, time to completion may not be as critical as once thought. Further study is needed to clarify the role of 4F-PCC in the management of TBI patients.
