Abstract
Prothrombin complex concentrate (PCC) is FDA approved for warfarin reversal but is often used for coagulopathy and hemorrhage in patients with liver disease. While studies have explored its use during liver transplant, less is known about its safety and efficacy for other indications in patients with liver disease. Our objective was to retrospectively compare INR and mortality in patients with liver disease treated with PCC versus plasma. After obtaining institutional review board approval, we conducted retrospective chart review of patients with liver disease who received PCC. Control patients with liver disease who received plasma alone were matched based on indication for treatment. Outcomes were first post-PCC or post-plasma INR and mortality during admission. Twenty-one patients with liver disease who received PCC were identified; 21 who received plasma alone were matched. Two PCC patients and 1 plasma patient were excluded due to insufficient data in the medical record to calculate MELD scores. Statistics were calculated in Microsoft Excel (Version 1901). The most frequent indications were coagulopathy reversal and hemorrhage. The most common liver disease etiologies in both groups were alcohol and hepatitis C. The mean MELD score for the PCC group was higher than that for the plasma group (35 ± 7 vs 27 ± 9, P = .01). Mean baseline INR was similar between groups (PCC group, 4.0 ± 2.8 vs plasma group, 3.8 ± 3.8, P = .88). While INR decreased somewhat without a significant difference between groups (PCC group, 2.8 ± 1.5 vs plasma group, 2.4 ± 1.2, P = .44), mortality during admission was significantly higher in patients who received PCC (15 [71%] vs 5 [33%], P < .01). Of the 15 PCC patients who died, 5 died with hemorrhage as a contributing factor, 3 with disseminated intravascular coagulopathy, and 1 with both; 1 other patient died with TIPS thrombus as a contributing factor. Of the 5 plasma patients who died during admission, 2 died with hemorrhage as a contributing factor, and none died with clotting complications. The difference in mortality between groups is likely confounded by more severe disease in the PCC group as evidenced by higher mean MELD score. It is unclear whether the higher number of bleeding and clotting complications in the PCC group is related to PCC administration or is a consequence of more advanced liver disease in these patients. The higher mean MELD score in the PCC group may reflect a tendency for providers to prescribe PCC for patients with more severe liver disease, who may not tolerate the large fluid boluses required for coagulopathy reversal with plasma. In conclusion, PCC does not appear to be superior to plasma for INR reversal in patients with liver disease. Further study is needed to determine efficacy and safety of PCC in patients with liver disease and should include comparison of patient groups with similar disease severity.
629: EVALUATION OF PROTHROMBIN COMPLEX CONCENTRATE FOR WARFARIN REVERSAL PRIOR TO HEART TRANSPLANT
