Analgesia & Resuscitation : Current ResearchISSN: 2324-903X

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Research Article, Analg Resusc Curr Res Vol: 5 Issue: 2

Comparing Three Eras of Hepatic Coagulopathy Normalization Using Coagulation Factor Concentrates

Melissa R Ferguson1, Cassie A Barton1*, Jesse Bierman1, Nathan D Mah1, Ran Ran2, David Martin3, Daniel Hagg4 and Thomas Deloughery5
1Department of Pharmacy, Oregon Health and Science University, USA
2Department of Emergency Medicine, Oregon Health and Science University, USA
3Department of Surgery, Oregon Health and Science University, USA
4Department of Pulmonology and Critical Care Medicine, Oregon Health and Science University, USA
5Departments of Medicine, Pathology, and Pediatrics, Oregon Health and Science University, USA
Corresponding author : Cassie A. Barton
Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, CR 9-4, Portland, OR-97239, USA
Tel: +15034944660
Fax: +15034940011
E-mail: [email protected]
Received: May 18, 2016 Accepted: July 13, 2016 Published: July 21, 2016
Citation: Ferguson MR, Barton CA, Bierman J, Mah ND, Ran R, et al. (2016) Comparing Three Eras of Hepatic Coagulopathy Normalization Using Coagulation Factor Concentrates. Analg Resusc: Curr Res 5:2. doi:10.4172/2324-903X.1000141

Abstract

Objective: To evaluate the efficacy and safety of three different normalization strategies utilizing coagulation factor concentrates (CFCs) in patients with hepatic coagulopathy of either acute or chronic etiology experiencing a life-threatening bleed or need for normalization of coagulopathy prior to invasive procedure.
Design: Retrospective analysis.
Setting: University-affiliated academic medical center.
Patients: Adult patients admitted with hepatic dysfunction who received CFC for treatment of an active bleed or to normalize coagulopathy prior to an invasive procedure.
Interventions: None.
Measurements and main results: Patients were stratified into three treatment groups dependent upon which CFC was administered: recombinant factor VIIa (rfVIIa), three factor prothrombin complex concentrate (3F-PCC)/rfVIIa, or four factor prothrombin complex concentrate (4F-PCC). Fifty patients were included who received rfVIIa (n=19, 38%), 3F-PCC/rfVIIa (n=9, 18%), or 4F-PCC (n=22, 44%) during the study period. The groups were well-matched regarding age, weight, sex, hospital and ICU length of stay, baseline coagulation labs, and characteristics of liver dysfunction. All patients in the rfVIIa and 3F-PCC/rfVIIa groups achieved an INR <1.6 within four hours of first CFC use. Eight patients (36.4%) in the 4F-PCC group met the same endpoint within four hours of administration. Transfusion requirements did not differ before and after CFC administration in all groups. TE complications occurred in eight (16%) patients.
Conclusions: CFCs appear to be effective for the normalization of INR in patients with hepatic coagulopathy in the setting of active bleeding or prior to invasive procedures.

Keywords: Blood coagulation factors; Coagulopathy; Liver failure; Prothrombin complex concentrate; Recombinant factor VIIa

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