TY - JOUR
T1 - Effectiveness of prothrombin complex concentrate for the treatment of bleeding: A systematic review and meta-analysis
AU - van den Brink, Daan P.
AU - Wirtz, Mathijs R.
AU - Neto, Ary Serpa
AU - Schöchl, Herbert
AU - Viersen, Victor
AU - Binnekade, Jan
AU - Juffermans, Nicole P.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - 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; 95% confidence interval [CI], 0.66-1.06; P =.13; I2 = 0%). However, in trauma patients, PCC administration, in addition to fresh frozen plasma, was associated with reduced mortality (odds ratio = 0.64; CI, 0.46-0.88; P =.007; I2 = 0%). PCC administration was associated with a reduction in blood loss in cardiac surgery patients (mean difference: −384; CI, −640 to −128, P =.003, I2 = 81%) and a decreased need for red blood cell transfusions when compared with standard care across a wide range of bleeding patients not taking anticoagulants (mean difference: −1.80; CI, −3.22 to −0.38; P =.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 red blood cell transfusions when compared with treatment strategies not involving PCC. In bleeding cardiac surgery patients, PCC administration reduced blood loss.
AB - 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; 95% confidence interval [CI], 0.66-1.06; P =.13; I2 = 0%). However, in trauma patients, PCC administration, in addition to fresh frozen plasma, was associated with reduced mortality (odds ratio = 0.64; CI, 0.46-0.88; P =.007; I2 = 0%). PCC administration was associated with a reduction in blood loss in cardiac surgery patients (mean difference: −384; CI, −640 to −128, P =.003, I2 = 81%) and a decreased need for red blood cell transfusions when compared with standard care across a wide range of bleeding patients not taking anticoagulants (mean difference: −1.80; CI, −3.22 to −0.38; P =.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 red blood cell transfusions when compared with treatment strategies not involving PCC. In bleeding cardiac surgery patients, PCC administration reduced blood loss.
KW - bleeding
KW - blood coagulation factors
KW - hemostasis
KW - meta-analysis
KW - prothrombin complex concentrate
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85088828832&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jth.14991
DO - https://doi.org/10.1111/jth.14991
M3 - Review article
C2 - 32638483
SN - 1538-7933
VL - 18
SP - 2457
EP - 2467
JO - Journal of thrombosis and haemostasis
JF - Journal of thrombosis and haemostasis
IS - 10
ER -