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Factor IX complex for the correction of traumatic coagulopathy

Joseph, Bellal MD; Amini, Albert MD; Friese, Randall S. MD; Houdek, Matthew BS; Hays, Daniel PharmD; Kulvatunyou, Narong MD; Wynne, Julie MD; O'Keeffe, Terence MD; Latifi, Rifat MD; Rhee, Peter MD

Journal of Trauma and Acute Care Surgery: April 2012 - Volume 72 - Issue 4 - p 828–834
doi: 10.1097/TA.0b013e318247c944
AAST Plenary Papers

BACKGROUND: Damage control resuscitation advocates correction of coagulopathy; however, options are limited and expensive. The use of prothrombin complex concentrate (PCC), also known as factor IX complex, can quickly accelerate reversal of coagulopathy at relatively low cost. The purpose of this study is to describe our experience in the use of factor IX complex in coagulopathic trauma patients.

METHODS: All patients receiving PCC at our Level I trauma center over a two-year period (2008–2010) were reviewed. PCC was used at the discretion of the trauma attending for treatment of coagulopathy, reversal of coumadin, and when recombinant factor VIIa was indicated.

RESULTS: Forty-five trauma patients received 51 doses of PCC. Sixty-two per cent were male and mean Injury Severity Score was 23 (±14.87). Standard dose was 25 units per kg and mean cost per patient was $1,022 ($504–3,484). Fifty-eight per cent of patients were on warfarin before admission. Mean international normalized ratio (INR) was decreased after PCC administration (p = 0.001). Packed red blood cell transfusion was also reduced after factor IX complex (p = 0.018). Mean INR was reduced in both the nonwarfarin (p = 0.001) and warfarin (p = 0.001) groups. Packed red blood cell transfusion was less in the nonwarfarin group (p = 0.002) however was not significant in the warfarin group. Subsequent thromboembolic events were observed in 3 of the 45 patients (7%). Mortality was 16 of 45 (36%).

CONCLUSION: PCC rapidly and effectively treats coagulopathy after traumatic injury. PCC therapy leads to a significant correction in INR in all trauma patients, regardless of coumadin use, and concomitant reduction in blood product transfusion. PCC should be considered as an effective tool to treat acute coagulopathy of trauma. Further prospective studies examining the safety, efficacy, cost, and outcomes comparing PCC and recombinant factor VIIa are needed.

LEVEL OF EVIDENCE: III, therapeutic study.

Tucson, Arizona

From the Division of Trauma, Critical Care and Emergency Surgery, University of Arizona College of Medicine, Tucson, Arizona.

Submitted: September 15, 2010, Received: December 21, 2011, Accepted: December 21, 2011.

Presented at the 69th Annual Meeting of the American Association for the Surgery of Trauma, September 22–25, 2010, Boston, Massachusetts.

Address for reprints: Bellal Joseph, MD, Department of Surgery, University of Arizona, College of Medicine, 1501 N. Campbell Avenue, Rm 5411, P.O. Box 245063, Tucson, AZ 85727-5063; email: bjoseph@surgery.arizona.edu.

© 2012 Lippincott Williams & Wilkins, Inc.