4-factor prothrombin complex concentrate is associated with improved survival in trauma related hemorrhage: a nationwide propensity matched analysis.

The authors conducted a retrospective study to evaluate outcomes of severely injured trauma patients who received 4-factor prothrombin complex concentrate (4-PCC) + fresh frozen plasma (FFP) compared to FPP alone. For this, they analysed two years (2015–2016) of the American College of Surgeons-Trauma Quality Improvement Program database. A large number of adult, seriously traumatised patients (86% with blunt trauma) were matched (234 in each group).

Four-PCC + FFP were associated with a decreased requirement for packed red blood cell and FFP transfusion compared to FFP alone. Platelet transfusion rates were similar in both groups. Patients who received 4-PCC + FFP had a lower mortality (17.5% vs. 27.7%; P = 0.01), lower rates of ARDS and AKI and a shorter hospital LOS. There was no difference in the rates of DVT and PE (both objectively demonstrated) between the two groups.

This interesting, albeit retrospective, study suggests that the addition of 4-PCC to FFP improves outcomes (mortality and severe adverse events) in patients with trauma-induced coagulopathy. Thrombotic complications were not increased by the addition of 4-PCC to FFP. Further randomised controlled studies are required to evaluate the efficacy and safety of the addition of PCC to the massive transfusion protocol.

– Jean-François Hardy