Prothrombin Complex Concentrate Utilization in Children's Hospitals

Jeffrey E. Lutmer; Christian Mpody; Eric A. Sribnick; Takaharu Karube; Joseph D. Tobias

doi:10.1055/s-0041-1731686

Journal of Pediatric Intensive Care, Table of Contents

J Pediatr Intensive Care 2023; 12(03): 219-227
DOI: 10.1055/s-0041-1731686

Original Article

Prothrombin Complex Concentrate Utilization in Children's Hospitals

Jeffrey E. Lutmer

¹Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States

,

Christian Mpody

²Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States

,

Eric A. Sribnick

³Department of Neurological Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States

,

Takaharu Karube

¹Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States

,

Joseph D. Tobias

²Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States

› Author Affiliations

Abstract

Prothrombin complex concentrates (PCCs) are used to manage bleeding in critically ill children. We performed a repeat cross-sectional study using the Pediatric Health Information System registry to describe PCC utilization in the U.S. children's hospitals over time and determine the relationship between PCC use and specific risk factors for bleeding. We included children < 18 years who received three-factor or four-factor PCC during hospital admission between January 2015 and December 2020 to describe the association between PCC therapy, anticoagulation therapies, and inherited or acquired bleeding diatheses. PCC use steadily increased over the 6-year study period (from 1.3 to 4.6 per 10,000 encounters). Patients exhibited a high degree of critical illness, with 85.0% requiring intensive care unit admission and a mortality rate of 25.8%. PCCs were used in a primarily emergent or urgent fashion (32.6 and 39.3%, respectively) and more frequently in surgical cases (79.0% surgical vs. 21.0% medical). Coding analysis suggested a low rate of chronic anticoagulant use which was supported by review of concomitant anticoagulant medications. PCC use is increasing in critically ill children and does not correlate with specific anticoagulant therapy use or other bleeding risk factors. These findings suggest PCC use is not limited to vitamin K antagonist reversal. Indications, efficacy, and safety of PCC therapy in children require further study.

Keywords

prothrombin complex concentrates - warfarin - anticoagulants - coagulopathy - bleeding

Full Text

References

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