title: Prothrombin complex concentrate: an effective therapy in reversing the coagulopathy of traumatic brain injury.
abstract: BACKGROUND
  Coagulopathy in patients with traumatic brain injury (TBI) is a well-studied concept. Prothrombin complex concentrate (PCC) has been shown to be an effective treatment modality for correction of TBI coagulopathy. However, its use and effectiveness compared with recombinant factor VII (rFVIIa) in TBI has not been established. The purpose of this study was to compare PCC and rFVIIa for the correction of TBI coagulopathy.
  
  
  METHODS
  All patients with a TBI and an induced or acquired coagulopathy whom received rFVIIa or PCC at our Level I trauma center during a 4-year period were reviewed. Data collected included demographics, changes in international normalized ratio and blood products transfusion, craniotomy rates, and time to neurosurgical intervention, thromboembolic complications, and mortality differences.
  
  
  RESULTS
  The study was composed of 85 TBI patients, of whom 64 patients received PCC while 21 patients received rFVIIa. PCC group were more likely to be on coumadin (44% vs. 14%, p = 0.01). There was a significant decline in packed red blood cell transfusion and fresh frozen plasma after PCC administration (p < 0.01). There was no statistically significant difference in the craniotomy rate (28% vs. 10 %, p = 0.1) or the mean time to intervention between the two groups (201 [33] vs. 230 [10], p = 0.9). Mortality rates were lower in the PCC group compared with rFVIIa (67% vs. 47%, p = 0.02). Subsequent thromboembolic event was seen in one patient on rFVIIa. Mean cost of treatment per patient on PCC was $1,007 compared with $5,757 for rFVIIa (p < 0.01).
  
  
  CONCLUSIONS
  PCC is safe and effective for treating coagulopathy in TBI patients, while reducing costs and resource use. PCC should be considered as an effective therapy to treat both acquired and induced coagulopathy in TBI with or without prehospital coumadin use.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona 85724, USA. bjoseph@surgery.arizona.edu
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Pantelis
authors.initials: P
authors.lastname: Hadjizacharia
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D001930:Brain Injuries / Q000097:blood / Q000150:complications*; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D015942:Factor VIIa