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

Current Opinion in Anaesthesiology, vol. 38, pp. 120–128

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.

Authors 2

1. Oliver Grottke corresponding Aachen Department of Anesthesiology

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Anesthesiology, RWTH Aachen University Hospital, Aachen

2. Lars Heubner

   Technische Universität Dresden · University Hospital Carl Gustav Carus

   Affiliation as printed

   Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany