title: Management of Bleeding in Post-liver Disease, Surgery and Biopsy in Patients With High Uncorrected International Normalized Ratio With Prothrombin Complex Concentrate: An Iranian Experience.
abstract: BACKGROUND
  To evaluate the efficacy of prothrombin complex concentrate (PCC) in the management of bleeding in patients with liver disease and patients undergoing surgery or biopsy who had a high uncorrected international normalized ratio (INR).
  
  
  OBJECTIVE
  In this study, we examined an Iranian sample and investigated the efficacy of PCC to manage bleeding in patients with liver disease and also patients with high uncorrected INR who were scheduled for surgery or biopsy.
  
  
  METHODS
  A total of 25 patients including 16 patients with post-liver disease bleeding (group 1) and 9 patients with high uncorrected INR who were scheduled for surgery or biopsy (group 2) were enrolled. All patients were treated with 25 IU/kg PCC, and efficacy was defined as any reduction in or cessation of bleeding episodes and correction of INR before surgery or biopsy. The patients were also evaluated for any adverse effects.
  
  
  RESULTS
  INR decreased significantly in both groups of patients, with no bleeding episodes during or after the study in group 1 and during or after surgery/biopsy in group 2. All patients tolerated the therapy well without any significant adverse effects.
  
  
  CONCLUSIONS
  The efficacy of PCC therapy was satisfactory in this study. PCC therapy in patients with liver disease and patients undergoing surgery or biopsy seems to be effective and safe, and may be a good treatment strategy for these patients, if fresh frozen plasma or vitamin K are not effective.
authors.affiliation: Iranian Hospital, Dubai, UAE ; Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Parand
authors.affiliation: Pediatrics Gastroenterology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Naser
authors.initials: N
authors.lastname: Honar
authors.affiliation: Pediatric Intensive Care Unit, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Aflaki
authors.affiliation: Pediatrics Gastroenterology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Mohammad Hadi
authors.initials: MH
authors.lastname: Imanieh
authors.affiliation: Pediatrics Gastroenterology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Haghighat
authors.affiliation: Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Nader
authors.initials: N
authors.lastname: Cohan
authors.affiliation: Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Sezaneh
authors.initials: S
authors.lastname: Haghpanah
authors.affiliation: Department of Hematology, University Hospital of Modena, Modena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marietta
authors.affiliation: Pediatric Intensive Care Unit, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Serati
authors.affiliation: Pediatric Intensive Care Unit, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Saeedeh
authors.initials: S
authors.lastname: Haghbin
authors.affiliation: Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Mehran
authors.initials: M
authors.lastname: Karimi
keywords: General Surgery; International Normalized Ratio; Liver Diseases; Prothrombin Complex Concentrates