Experience using prothrombin complex concentrate in a hospital emergency department

Quintana Díaz M, Borobia AM, Zegarra C, Rivera Núñez MA, Martínez Virto AM, García Erce JA

Objective: To describe short-term results of emergency department (ED) use of a

prothrombin complex concentrate (PCC) in the context of routine hospital practice.

Methods: Retrospective observational nonintervention study including all patients who

were injected with a PCC in the ED during 19 months. Demographic, clinical, laboratory,

and treatment data were gathered from patient records. The main outcome variables were

an international normalized ratio (INR) of 1.5 or less and resolution of bleeding after

injection of the PCC. Secondary outcomes were hospital admission, in-hospital and 6-

month mortality, and occurrence of pulmonary embolism within 6 months of PCC

injection. The patient sample was analyzed according to the indication for PCC use.

Results: Seventy-five patients with a mean (SD) age of 77.2 (12.18) years were included;

45 (60%) were men. Sixty-six patients (88%) had received an anticoagulant. The

indications for PCC use were severe hemorrhage in 48 (64.0%), minor bleeding in 8

(10.6%), surgery or another invasive procedure in 15 (20.0%), and INR elevation

without evident bleeding in 2 (2.7%). The mean PCC dosage was 1271 (416) IU. An INR

of 1.5 or less was achieved in 54 of the 75 patients (72.0%); bleeding stopped in 53

(94.7%) of those with severe hemorrhage. Sixty-one patients (81.3%) were admitted,

and 16 (21.3%) died in hospital. At 6 months, 1 patient (1.3%) had died after discharge

and 2 (2.7%) had experienced pulmonary thromboembolism.

Conclusion: Use of a PCC in addition to usual management is effective and relatively

safe for routine ED practice

Borobia AM, García Erce JA, Martínez Virto AM, Quintana Díaz M, Rivera Núñez MA, Zegarra C