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DOI: 10.1055/s-0041-1731686
Prothrombin Complex Concentrate Utilization in Children's Hospitals
Abstract
Prothrombin complex concentrates (PCCs) are used to manage bleeding in critically ill children. We performed a repeat cross-sectional study using the Pediatric Health Information System registry to describe PCC utilization in the U.S. children's hospitals over time and determine the relationship between PCC use and specific risk factors for bleeding. We included children < 18 years who received three-factor or four-factor PCC during hospital admission between January 2015 and December 2020 to describe the association between PCC therapy, anticoagulation therapies, and inherited or acquired bleeding diatheses. PCC use steadily increased over the 6-year study period (from 1.3 to 4.6 per 10,000 encounters). Patients exhibited a high degree of critical illness, with 85.0% requiring intensive care unit admission and a mortality rate of 25.8%. PCCs were used in a primarily emergent or urgent fashion (32.6 and 39.3%, respectively) and more frequently in surgical cases (79.0% surgical vs. 21.0% medical). Coding analysis suggested a low rate of chronic anticoagulant use which was supported by review of concomitant anticoagulant medications. PCC use is increasing in critically ill children and does not correlate with specific anticoagulant therapy use or other bleeding risk factors. These findings suggest PCC use is not limited to vitamin K antagonist reversal. Indications, efficacy, and safety of PCC therapy in children require further study.
Note
This work was performed at the Nationwide Children's Hospital.
Publication History
Received: 11 March 2021
Accepted: 20 May 2021
Article published online:
03 July 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 Witmer CM, Huang YS, Lynch K, Raffini LJ, Shah SS. Off-label recombinant factor VIIa use and thrombosis in children: a multi-center cohort study. J Pediatr 2011; 158 (05) 820-825.e1
- 2 Ashikhmina E, Said S, Smith MM. et al. Prothrombin complex concentrates in pediatric cardiac surgery: the current state and the future. Ann Thorac Surg 2017; 104 (04) 1423-1431
- 3 Karube T, Andersen C, Tobias JD. Single-center use of prothrombin complex concentrate in pediatric patients. J Pediatr Intensive Care 2020; 9 (02) 106-112
- 4 Levy JH, Ghadimi K, Quinones QJ, Bartz RR, Welsby I. Adjuncts to blood component therapies for the treatment of bleeding in the intensive care unit. Transfus Med Rev 2017; 31 (04) 258-263
- 5 Levy JH, Ghadimi K, Waldron NH, Connors JM. Using plasma and prothrombin complex concentrates. Semin Thromb Hemost 2020; 46 (01) 32-37
- 6 Ghadimi K, Levy JH, Welsby IJ. Prothrombin complex concentrates for bleeding in the perioperative setting. Anesth Analg 2016; 122 (05) 1287-1300
- 7 Zeeshan M, Hamidi M, Feinstein AJ. et al. Four-factor prothrombin complex concentrate is associated with improved survival in trauma-related hemorrhage: a nationwide propensity-matched analysis. J Trauma Acute Care Surg 2019; 87 (02) 274-281
- 8 Frontera JA, Lewin III JJ, Rabinstein AA. et al. Guideline for reversal of antithrombotics in intracranial hemorrhage: executive summary. A statement for healthcare professionals from the Neurocritical Care Society and the Society of Critical Care Medicine. Crit Care Med 2016; 44 (12) 2251-2257
- 9 Baugh CW, Levine M, Cornutt D. et al. Anticoagulant reversal strategies in the emergency department setting: recommendations of a multidisciplinary expert panel. Ann Emerg Med 2020; 76 (04) 470-485
- 10 Czaja AS, Reiter PD, Schultz ML, Valuck RJ. Patterns of off-label prescribing in the pediatric intensive care unit and prioritizing future research. J Pediatr Pharmacol Ther 2015; 20 (03) 186-196
- 11 Chaudhary R, Sharma T, Garg J. et al. Direct oral anticoagulants: a review on the current role and scope of reversal agents. J Thromb Thrombolysis 2020; 49 (02) 271-286
- 12 Chan AK, Leaker M, Burrows FA. et al. Coagulation and fibrinolytic profile of paediatric patients undergoing cardiopulmonary bypass. Thromb Haemost 1997; 77 (02) 270-277
- 13 Sisti DJ, Williams GD, Ding V. et al. The use of prothrombin complex concentrate as a warfarin reversal agent in pediatric patients undergoing orthotopic heart transplantation. Paediatr Anaesth 2020; 30 (05) 564-570
- 14 Machovec KA, Jooste EH. Pediatric transfusion algorithms: coming to a cardiac operating room near you. J Cardiothorac Vasc Anesth 2019; 33 (07) 2017-2029
- 15 Werner MJM, Adelmeijer J, de Meijer VE. et al. In vitro evaluation of pro- and anticoagulant drugs in children with end-stage liver disease undergoing liver transplantation. Thromb Haemost 2020; 120 (09) 1240-1247
- 16 Voulgarelis S, Vitola B, Lerret SM, Hong JC, Scott JP. Perioperative anticoagulation practices for pediatric liver transplantation. Pediatr Transplant 2018; 22 (04) e13193
- 17 Marcos-Jubilar M, García Erce JA, Martínez-Calle N, Páramo JA, Martínez Virto A, Quintana-Díaz M. Safety and effectiveness of a prothrombin complex concentrate in approved and off-label indications. Transfus Med 2019; 29 (04) 268-274