Prothrombin Complex Concentrate Utilization in Children's Hospitals

Abstract

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.

Prothrombin Complex Concentrate to Treat Coagulation Disturbances in Pediatric Patients With Intracranial Pathology Including Traumatic Brain Injury

“…Future randomized controlled trials should be utilized to establish effective doses for PCC in pediatric patients based on clinical and laboratory parameters, identify optimal protocols to define indications for PCC, define optimal laboratory parameters to evaluate clinical efficacy, and monitor for adverse effects. The need for such trials is demonstrated by the increasing off-label use of PCCs over the past 4 years in pediatric patients, especially in critically ill patients with a high risk for mortality [25].…”