L. S. Kuzomunhu1, M. M. Fleming2, R. R. Jean2, K. Y. Pei2 1Yale University School Of Medicine,New Haven, CT, USA 2Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA
Introduction: Prothrombin complex concentrate (PCC) is indicated in patients sustaining traumatic intracranial hemorrhage (ICH) while taking warfarin, but the optimal timing is unknown. This study evaluates the effect of timing to PCC administration on outcomes including intracranial hemorrhage expansion and length of hospital stay.
Methods: We retrospectively reviewed patients presenting with ICH who received PCC at our tertiary care hospital between March 2013 to November 2017. Only patients on warfarin and with repeat computed tomography of head were included. Time to PCC was defined as the time from order entry to patient administration as documented contemporaneously in the electronic health record. Time was stratified as early (≤30 minutes) or late (>30 minutes). Multivariable logistic regression with stepwise selection was used to predict ICH expansion between initial and repeat cross sectional imaging. Linear regression identified predictors for increased hospital and intensive care unit length of stay.
Results: In total, 127 patients with ICH on warfarin were included for analysis. Mean time to PCC administration was 82.3 ± 43.7 minutes. The majority of patients who demonstrated expansion of ICH (31.5% of patients) had admission motor Glasgow Coma Score (GCS) less than 6 (p<0.05), a higher Charlson Comorbidity Index (CCI) (p<0.05) and higher inpatient mortality (p<0.01). On multivariable analysis, only admission motor GCS<6 was independently associated with ICH expansion (OR 3.016, 95% CI 1.158-7.858). Time to PCC (early versus late), admission INR and anticoagulation indication were not associated with ICH expansion. On linear regression admission motor GCS<6 was associated with increased length of ICU stay (β=8.261, SE 2.070, p=0.0001); however no other patient characteristics or PCC administration time was associated with hospital length of stay.
Conclusion: Timing to PCC administration was not associated with ICH expansion or mortality after traumatic ICH. Further multi-institutional studies are needed to evaluate clinical and process measures to streamline PCC administration.