title: Prothrombin complex concentrate use in coagulopathy of lethal brain injuries increases organ donation.
abstract: Coagulopathy is a defined barrier for organ donation in patients with lethal traumatic brain injuries. The purpose of this study was to document our experience with the use of prothrombin complex concentrate (PCC) to facilitate organ donation in patients with lethal traumatic brain injuries. We performed a 4-year retrospective analysis of all patients with devastating gunshot wounds to the brain. The data were analyzed for demographics, change in international normalized ratio (INR), and subsequent organ donation. The primary end point was organ donation. Eighty-eight patients with lethal traumatic brain injury were identified from the trauma registry of whom 13 were coagulopathic at the time of admission (mean INR 2.2 ± 0.8). Of these 13 patients, 10 patients received PCC in an effort to reverse their coagulopathy. Mean INR before PCC administration was 2.01 ± 0.7 and 1.1 ± 0.7 after administration (P < 0.006). Correction of coagulopathy was attained in 70 per cent (seven of 10) patients. Of these seven patients, consent for donation was obtained in six patients and resulted in 19 solid organs being procured. The cost of PCC per patient was $1022 ± 544. PCC effectively reveres coagulopathy associated with lethal traumatic brain injury and enabled patients to proceed to organ donation. Although various methodologies exist for the treatment of coagulopathy to facilitate organ donation, PCC provides a rapid and cost-effective therapy for reversal of coagulopathy in patients with lethal traumatic brain injuries.
authors.affiliation: Division of Trauma, Burns, Critical Care, and Emergency Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Daniel
authors.initials: D
authors.lastname: Hays
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.forename: Terence
authors.initials: T
authors.lastname: O' Keeffe
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Rainer
authors.initials: R
authors.lastname: Gruessner
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology*; D001779:Blood Coagulation Factors / Q000191:economics / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014948:Wounds, Gunshot / Q000150:complications* / Q000401:mortality
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates