title: Assessing the Efficacy of Prothrombin Complex Concentrate in Multiply Injured Patients With High-Energy Pelvic and Extremity Fractures.
abstract: OBJECTIVE
  Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients.
  
  
  METHODS
  Two-year retrospective analysis.
  
  
  METHODS
  Our level I trauma center.
  
  
  METHODS
  All coagulopathic [International normalized ratio (INR) ≥1.5] trauma patients. Patients with femur, tibia, or pelvic fracture were included. Patients were divided into 2 groups: PCC (single dose) and fresh frozen plasma (FFP). Patients in the 2 groups were matched using propensity score matching.
  
  
  METHODS
  Time to correction of INR, time to intervention, development of thromboembolic complications, mortality, and cost of therapy.
  
  
  RESULTS
  A total of 81 patients (PCC: 27, FFP: 54) were included. Patients who received PCC had faster correction of INR and shorter time to surgical intervention in comparison to patients who received FFP. PCC therapy was also associated with lower overall blood product requirement (P = 0.02) and lower transfusion costs (P = 0.0001).
  
  
  CONCLUSIONS
  In a matched cohort of multiply injured patients with pelvic and/or lower extremity fractures, administration of a single dose of PCC significantly reduced the time to correction of INR and time to intervention compared with patients who received FFP therapy. This may allow orthopaedic surgeons to more safely proceed with early, definitive fixation strategies.
  
  
  METHODS
  Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Trauma, Critical Care, Burns and Emergency Surgery, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Harrison
authors.forename: Tianyi
authors.initials: T
authors.lastname: Swartz
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Ansab A
authors.initials: AA
authors.lastname: Haider
authors.forename: Tahereh O
authors.initials: TO
authors.lastname: Jokar
authors.forename: David
authors.initials: D
authors.lastname: Burk
authors.forename: Ali
authors.initials: A
authors.lastname: Mahmoud
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D001130:Arizona / Q000453:epidemiology; D001778:Blood Coagulation Disorders / Q000401:mortality* / Q000517:prevention & control*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D015984:Causality; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007869:Leg Injuries / Q000401:mortality* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality* / Q000628:therapy; D010384:Pelvic Bones / Q000187:drug effects / Q000293:injuries; D011292:Premedication / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates