Influence of prothrombin complex concentrates on plasma coagulation in critically ill patients.
OBJECTIVE
To evaluate thrombogenicity of prothrombin complex concentrates (PCCs) in critically ill patients.


METHODS
Prospective clinical study.


METHODS
Medical intensive care unit at a university hospital.


METHODS
16 consecutive patients suffering from acquired deficiencies of coagulation factors and with either overt bleeding from any site or a planned invasive procedure.


METHODS
2000 factor IX units of PCCs intravenously.


RESULTS
Prothrombin time (PT), activated partial prothrombin time, fibrinogen, platelet count, plasma levels of coagulation factors II, V, VII, VIII, IX, X, antithrombin, protein C, thrombin-antithrombin complex (TAT), prothrombin fragment F(1+2), and the fibrin degradation product D-dimer were measured prior to and 1, 3, and 24 h after administration of PCCs. PT as well as coagulation factors II, VII, IX, and X, TAT, and F(1+2) showed a significant increase after administration of PCCs. All other parameters remained unchanged.


CONCLUSIONS
Administration of PCCs induces thrombin generation. No evidence for induction of disseminated intravascular coagulation in biochemical terms could be found. When rapid correction of acquired coagulation factor disturbances is warranted, the use of PCCs seems reasonable, but the elevated risk of intravascular thrombus formation should be kept in mind.
Staudinger
T
T
Department of Chemical Laboratory Diagnosis, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. thomas.staudinger@akh-wien.ac.at
Frass
M
M
Rintelen
C
C
Quehenberger
P
P
Wagner
O
O
Stoiser
B
B
Locker
G J
GJ
Laczika
K
K
Knapp
S
S
Watzke
H
H
D000328:Adult; D000368:Aged; D000991:Antithrombins / Q000032:analysis; D001779:Blood Coagulation Factors / Q000009:adverse effects / Q000032:analysis / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D020147:Coagulation Protein Disorders / Q000097:blood* / Q000188:drug therapy*; D016638:Critical Illness; D016903:Drug Monitoring; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D011486:Protein C / Q000032:analysis; D013917:Thrombin / Q000032:analysis / Q000187:drug effects; D013927:Thrombosis / Q000139:chemically induced
D000991:Antithrombins; D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; C025667:prothrombin complex concentrates; D013917:Thrombin