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Effectiveness of prothrombin complex concentrate for the treatment of bleeding: A systematic review and meta-analysis

Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands. Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, The Netherlands. Department of Trauma Surgery, Amsterdam UMC, Amsterdam, The Netherlands. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, So Paulo, Brazil. Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria. Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. Department of Anesthesiology, Amsterdam UMC, The Netherlands.

J Thromb Haemost. 2020
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Abstract
Prothrombin complex concentrate(PCC) is increasingly being used as a treatment for major bleeding in patients who are not taking anticoagulants. The aim of this systematic review and meta-analysis is to evaluate the effectiveness of PCC administration for the treatment of bleeding in patients not taking anticoagulants. Studies investigating the effectivity of PCC to treat bleeding in adult patients and providing data on either mortality or blood loss were eligible. Data were pooled using Mantel-Haenszel random effects meta-analysis or inverse variance random effects meta-analysis. From 4668 identified studies, 17 observational studies were included. In all patient groups combined, PCC administration was not associated with mortality (odds ratio=0.83; confidence interval =0.66 - 1.06; p=0.13; I2=0%). However, in trauma patients, PCC administration, in addition to fresh frozen plasma, was associated with reduced mortality (odds ratio=0.64; confidence interval=0.46-0.88; p=0.007; I2=0%). PCC administration was associated with a reduction in blood loss in cardiac surgery patients(mean difference: -384; confidence interval =-640 - -128, p=0.003, I2=81%) and a decreased need for red blood cell transfusions when compared to standard care across a wide range of bleeding patients not taking anticoagulants (mean difference: -1.80; confidence interval =-3.22 - -0.38; p=0.01; I2=92%. In conclusion, PCC administration was not associated with reduced mortality in the whole cohort but did reduce mortality in trauma patients. In bleeding patients, PCC reduced the need for RBC transfusions when compared to treatment strategies not involving PCC. In bleeding cardiac surgery patients, PCC administration reduced blood loss.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine