Abstract Number: PB0321
Meeting: ISTH 2021 Congress
Background: Prothrombin complex concentrate (PCC) is a commonly used blood product to correct bleeding related to warfarin, as well as Direct Oral AntiCoagulants (DOACS). Additionally there is a suggestion that PCC can be used to correct coagulopathy related to acquired disease (e.g. hepatic disease). These products contain four clotting factors to replace those inhibited or absent. To date, there has been no published standard for the optimum time to administration.
Aims: For anticoagulant related haemorrhage, our centre has adopted a one hour “decision-to -needle” based on the short half-life of factor VII in PCC. We also permit use of PPC to correct coagulopathy in selected patients with acquired factor deficiencies. We reviewed our clinical practice of the prescribing of PCC for these two indications.
Methods: We reviewed the clinical records of every patient who administered PCC in our centre. The indication was reviewed. For patients with anticoagulant-induced major bleeding, time from decision to administration was recorded. For every case that missed the one hour target, a reason for variance was sought. For all patients, complication rates and survival data at 30 days was collected.
Results: Over one year PCC was administered in 99 occasions for anticoagulant-related bleeding Successful administration within an hour was only recorded in 14% of cases. The median time to administration was 111 minutes. Reasons for delay are recorded in table 1.
PCC was administered on 69 occasions to correct acquired coagulopathy. There was no increased incidence of thrombosis or mortality related to PCC at 30 days.
|Reason for delay||Occurrence||% of total delays|
|Required confirmation with haematology registrar||7||11.1|
|Slow processing by laboratory*||15||23.8|
|Issues with no porters to collect the ordered beriplex**||7||11.1|
|Incorrect dose ordered initially||10||15.9|
|Clinical workload and unstable patient||17||27.0|
|Weight of patient||1||1.59|
|Octaplex ordered instead of beriplex||2||3.17|
|Nursing staff not trained to give****||1||1.59|
Conclusions: Our data suggests that there is a failure to give PCC in a timely manner. We have devised a set of measures to improve administration. Our data also provides additional evidence that PCC is safe for use in acquired coagulopathies with no increase in morbidity or mortality.
To cite this abstract in AMA style:Robinson M, Hickman C. A Service Evaluation of Prothrombin Complex Concentrate Use and Safe Administration Procedures in a Tertiary Hospital and Trauma Centre [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/a-service-evaluation-of-prothrombin-complex-concentrate-use-and-safe-administration-procedures-in-a-tertiary-hospital-and-trauma-centre/. Accessed December 8, 2021.
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