title: Efficacy of Prothrombin Complex Concentrate Treatment in Patients with Liver Coagulopathy Who Underwent Various Invasive Hepatobiliary and Gastrointestinal Procedures.
abstract: BACKGROUND
  Prothrombin complex concentrates (PCCs) containing prothrombin, factors VII, IX, and X, as well as the inhibitors protein C and S have been used as an emergent reversal for oral anticoagulation therapy. The use of PCCs in hepatobiliary disorder patients or patients with liver coagulopathy who need to undergo invasive procedures has not been well studied.
  
  
  OBJECTIVE
  To evaluate the efficacy of PCC treatment in order to control or prevent bleeding complications in patients with liver coagulopathy who undergo various invasive procedures.
  
  
  METHODS
  This was a prospective, open-label, non-randomized, before-and-after study in patients with hepatobiliary disorders who underwent invasive procedures accompanied by liver impairment and received PCC injection (Cofact(®), Sanquin, The Netherlands). Patients with coagulopathy from various causes were recruited consecutively. Data collected were the episodes of bleeding, liver function test and the international normalized ratio (INR) before and after PCC therapy. The primary endpoint was INR change after treatment, while secondary endpoints included bleeding control and bleeding event after treatment.
  
  
  RESULTS
  Thirty patients (17 men, 13 women) were enrolled. Patients' mean age was 57.0 + 15.5 years. Liver cirrhosis was found in 14 patients (46.7%). The procedures consisted of liver biopsy, liver abscess aspiration, abdominal paracentesis, therapeutic upper gastrointestinal endoscopy, abdominal surgery, endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage. After treatment, 25 patients (83.3%) showed a decreased median INR (from 1.6 to 1.3) (p < 0.001, Wilcoxon's signed-rank test). Five patients failed to show INR reduction. No new bleeding event related to the invasive procedures was observed.
  
  
  CONCLUSIONS
  PCC treatment is effective to control and prevent bleeding complications in patients with liver coagulopathy who undergo invasive procedures.
authors.affiliation: Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia; Hepatobiliary Division, Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
authors.forename: Cosmas Rinaldi A
authors.initials: CR
authors.lastname: Lesmana
authors.affiliation: Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.
authors.forename: Lidwina
authors.initials: L
authors.lastname: Cahyadinata
authors.affiliation: Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.
authors.forename: Levina S
authors.initials: LS
authors.lastname: Pakasi
authors.affiliation: Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia; Hepatobiliary Division, Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
authors.forename: Laurentius A
authors.initials: LA
authors.lastname: Lesmana
keywords: International normalized ratio; Liver cirrhosis; Liver coagulopathy; Prothrombin complex concentrate