title: Factor IX complex for the correction of traumatic coagulopathy.
abstract: BACKGROUND
  Damage control resuscitation advocates correction of coagulopathy; however, options are limited and expensive. The use of prothrombin complex concentrate (PCC), also known as factor IX complex, can quickly accelerate reversal of coagulopathy at relatively low cost. The purpose of this study is to describe our experience in the use of factor IX complex in coagulopathic trauma patients.
  
  
  METHODS
  All patients receiving PCC at our Level I trauma center over a two-year period (2008-2010) were reviewed. PCC was used at the discretion of the trauma attending for treatment of coagulopathy, reversal of coumadin, and when recombinant factor VIIa was indicated.
  
  
  RESULTS
  Forty-five trauma patients received 51 doses of PCC. Sixty-two per cent were male and mean Injury Severity Score was 23 (± 14.87). Standard dose was 25 units per kg and mean cost per patient was $1,022 ($504-3,484). Fifty-eight per cent of patients were on warfarin before admission. Mean international normalized ratio (INR) was decreased after PCC administration (p = 0.001). Packed red blood cell transfusion was also reduced after factor IX complex (p = 0.018). Mean INR was reduced in both the nonwarfarin (p = 0.001) and warfarin (p = 0.001) groups. Packed red blood cell transfusion was less in the nonwarfarin group (p = 0.002) however was not significant in the warfarin group. Subsequent thromboembolic events were observed in 3 of the 45 patients (7%). Mortality was 16 of 45 (36%).
  
  
  CONCLUSIONS
  PCC rapidly and effectively treats coagulopathy after traumatic injury. PCC therapy leads to a significant correction in INR in all trauma patients, regardless of coumadin use, and concomitant reduction in blood product transfusion. PCC should be considered as an effective tool to treat acute coagulopathy of trauma. Further prospective studies examining the safety, efficacy, cost, and outcomes comparing PCC and recombinant factor VIIa are needed.
authors.affiliation: Department of Surgery, University of Arizona, College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85727-5063, USA. bjoseph@surgery.arizona.edu
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Albert
authors.initials: A
authors.lastname: Amini
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Matthew
authors.initials: M
authors.lastname: Houdek
authors.forename: Daniel
authors.initials: D
authors.lastname: Hays
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000368:Aged; D001778:Blood Coagulation Disorders / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D017707:Erythrocyte Transfusion; D005164:Factor IX / Q000008:administration & dosage / Q000627:therapeutic use*; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D019934:International Normalized Ratio; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications / Q000188:drug therapy*
chemical_list: D011994:Recombinant Proteins; D014859:Warfarin; D005164:Factor IX; C103587:recombinant FVIIa; D015942:Factor VIIa