3-Factor Versus 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three

Zeeshan, Muhammad; Hamidi, Mohammad; Kulvatunyou, Narong; Jehan, Faisal; OʼKeeffe, Terence; Khan, Muhammad; Rashdan, Lana; Tang, Andrew; Zakaria, El Rasheid; Joseph, Bellal

doi:10.1097/shk.0000000000001240

“…In the past few decades, impressive advances have been made in the understanding of coagulopathy following blunt and penetrating trauma resulting in promising clinical interventions to diagnose, prevent, and treat trauma induced coagulopathy (TIC) ( 1 – 5 ). While the extent of research in the burn population has lagged in comparison with other types of trauma, a growing body of knowledge elucidates many unique characteristics of BIC.…”

mentioning

confidence: 99%

Burn-Induced Coagulopathies: a Comprehensive Review

Ball

¹

,

Keyloun

²

,

Brummel‐Ziedins

³

et al. 2019

Shock

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Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and associated) coagulopathy is presented along with the current understanding of the effects of burn injury on the interactions among coagulation, fibrinolysis, and inflammation in the acute resuscitative phase and reconstructive phase of care. The role of conventional tests of coagulopathy and functional assays like thromboelastography or thromboelastometry will also be discussed. Finally, reported methods for the prevention and treatment of complications related to burn-induced coagulopathy will be reviewed.

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“…Factor VIIa has been used alone and in combination with PCC3 to compensate for the low amount of factor VII [14,15]. Activated PCC has been used off-label for EWR [54]. Given the differing composition of these products as containing active factor VII and that guidelines do not currently recommend these products for EWR, we chose to not include these products in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Emergent Warfarin Reversal: A Systematic Review and Meta-Analysis

Margraf

¹

,

Brown

²

,

Blue

³

et al. 2021

Preprint

0

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Background: Patients requiring emergent warfarin reversal (EWR) have been prescribed three-factor prothrombin complex concentrate (PCC3) and four-factor prothrombin complex concentrate (PCC4) to reverse the anticoagulant effects of warfarin. There is no existing systematic review and meta-analysis of studies directly comparing PCC3 and PCC4. Methods: The primary objective of this systematic review and meta-analysis was to determine the effectiveness of achieving study defined target INR goal after PCC3 or PCC4 administration. Secondary objectives were to determine the difference in safety endpoints, thromboembolic events (TE), and survival during the patients’ hospital stay. Random-effects meta-analysis models were used to estimate the odds ratios (OR), and heterogeneity associated with the outcomes. The Newcastle-Ottawa Scale was used to assess study quality, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: Ten full-text manuscripts and 5 abstracts provided data for the primary and secondary outcomes. Patients requiring emergent warfarin reversal had more than three times the odds of reversal to goal INR when they were given PCC4 compared to PCC3 (OR = 3.61, 95% CI: 1.97-6.60, p < 0.001). There was no meaningful clinical association or statistically significant result between PCC4 and PCC3 groups in TE (OR = 1.56, 95% CI: 0.83-2.91, p = 0.17), or survival during hospital stay (OR = 1.34, 95% CI: 0.81-2.23, p = 0.25). Conclusion: PCC4 is more effective than PCC3 in meeting specific predefined INR goals, and has similar safety profiles in patients requiring emergent reversal of the anticoagulant effects of warfarin.

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“…Studies comparing PCC3 to PCC4 outside of the setting of EWR have similar results. Zeeshan et al found faster correction of INR with PCC4 compared to PCC3 in a propensity-score-matched analysis of patients treated for coagulopathy of trauma (PCC4: n = 125, 365 minutes vs. PCC4: n = 125, 428 minutes, p < 0.01), fewer units of FFP transfused (6 units vs. 8 units, p < 0.03) [53]. Also, the incidence of TE and mortality were similar between the PCC groups.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3-Factor Versus 4-Factor Prothrombin Complex Concentrate For Emergent Warfarin Reversal: A Systematic Review And Meta-Analysis

Margraf

¹

,

Brown

²

,

Blue

³

et al. 2021

Preprint

0

View full text Add to dashboard Cite

Background: Patients requiring emergent warfarin reversal (EWR) have been prescribed three-factor prothrombin complex concentrate (PCC3) and four-factor prothrombin complex concentrate (PCC4) to reverse the anticoagulant effects of warfarin. There is no existing systematic review and meta-analysis of studies directly comparing PCC3 and PCC4. Methods: The primary objective of this systematic review and meta-analysis was to determine the effectiveness of achieving study defined target INR goal after PCC3 or PCC4 administration. Secondary objectives were to determine the difference in safety endpoints, thromboembolic events (TE), and survival during the patients’ hospital stay. Random-effects meta-analysis models were used to estimate the odds ratios (OR), and heterogeneity associated with the outcomes. The Newcastle-Ottawa Scale was used to assess study quality, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: Ten full-text manuscripts and 5 abstracts provided data for the primary and secondary outcomes. Patients requiring emergent warfarin reversal had more than three times the odds of reversal to goal INR when they were given PCC4 compared to PCC3 (OR = 3.61, 95% CI: 1.97-6.60, p < 0.001). There was no meaningful clinical association or statistically significant result between PCC4 and PCC3 groups in TE (OR = 1.56, 95% CI: 0.83-2.91, p = 0.17), or survival during hospital stay (OR = 1.34, 95% CI: 0.81-2.23, p = 0.25). Conclusion: PCC4 is more effective than PCC3 in meeting specific predefined INR goals, and has similar safety profiles in patients requiring emergent reversal of the anticoagulant effects of warfarin.

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3-Factor Versus 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three

Abstract: Level III, Therapeutic studies.

Cited by 22 publications

References 25 publications

Burn-Induced Coagulopathies: a Comprehensive Review

Burn-Induced Coagulopathies: a Comprehensive Review

Comparison of 3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Emergent Warfarin Reversal: A Systematic Review and Meta-Analysis

Comparison of 3-Factor Versus 4-Factor Prothrombin Complex Concentrate For Emergent Warfarin Reversal: A Systematic Review And Meta-Analysis

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