Restoring hemostasis with prothrombin complex concentrate: benefits and risks in trauma-induced coagulopathy.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Current Opinion in Anesthesiology Pub Date : 2025-04-01 Epub Date: 2025-02-13 DOI:10.1097/ACO.0000000000001464
Oliver Grottke, Lars Heubner
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引用次数: 0

Abstract

Purpose of this review: To provide evidence for the use of prothrombin complex concentrate (PCC) as a potential hemostatic treatment for trauma-induced coagulopathy with and without anticoagulants.

Recent findings: PCC is effective in enhancing thrombin generation and achieving hemostasis in traumatized patients under anticoagulants. For vitamin K antagonist (VKA) reversal, it shows superior efficacy over fresh frozen plasma, achieving rapid normalization of the international normalized ratio normalization and reduced transfusion needs. In direct oral anticoagulant (DOAC)-associated bleeding, PCC offers an alternative when specific antidotes are unavailable. However, evidence from randomized trials in the field of trauma and coagulopathy is limited, and the results have shown conflicting outcomes in terms of mortality reduction. Further, following PCC application, thromboembolic risks remain a particular concern. Monitoring tools such as thrombin generation assays and point-of-care tests show promise but are not universally available.

Summary: PCC is a valuable option for managing coagulopathy in specific settings, especially VKA and DOAC reversal. Based on current evidence, we caution against the use of PCC as a versatile hemostatic agent suitable for indications involving multiple clotting factor deficiencies for uncontrolled coagulopathic bleeding in trauma or other clinical settings outside anticoagulation reversal. The risk vs. benefit profile should be carefully examined, similar to any other agent.

凝血酶原复合浓缩物恢复止血:创伤性凝血病的益处和风险。
本综述的目的:为使用凝血酶原复合物浓缩物(PCC)作为有或无抗凝剂的创伤性凝血病的潜在止血治疗提供证据。最近的研究发现:PCC能有效地促进抗凝血剂作用下创伤患者凝血酶的生成和止血。对于维生素K拮抗剂(VKA)逆转,它显示出比新鲜冷冻血浆更优越的疗效,实现了国际标准化比率正常化的快速正常化,减少了输血需求。在直接口服抗凝剂(DOAC)相关出血中,当没有特定的解毒剂时,PCC提供了一种替代方法。然而,创伤和凝血功能障碍领域的随机试验证据有限,结果显示死亡率降低方面的结果相互矛盾。此外,PCC应用后,血栓栓塞风险仍然是特别关注的。监测工具,如凝血酶生成测定和点护理测试显示前景,但不是普遍可用。总结:PCC是治疗特定情况下凝血功能障碍的有价值的选择,特别是VKA和DOAC逆转。根据目前的证据,我们警告不要使用PCC作为一种多用途止血剂,适用于创伤或抗凝逆转以外的其他临床环境中不受控制的凝血性出血的多种凝血因子缺乏。与任何其他药物一样,应该仔细检查风险与收益情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
8.00%
发文量
207
审稿时长
12 months
期刊介绍: ​​​​​​​​Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Anesthesiology features hand-picked review articles from our team of expert editors. With fifteen disciplines published across the year – including cardiovascular anesthesiology, neuroanesthesia and pain medicine – every issue also contains annotated references detailing the merits of the most important papers.
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