The role of four-factor prothrombin complex concentrate in coagulopathy of trauma: A propensity matched analysis

J Trauma Acute Care Surg. 2018 Jul;85(1):18-24. doi: 10.1097/TA.0000000000001938.


Background: Coagulopathy is a common complication after severe trauma. The efficacy of 4-factor prothrombin complex concentrate (4-PCC) as an adjunct to fresh frozen plasma (FFP) in reversal of coagulopathy of trauma (COT) has not been studied. The aim of our study is to compare 4-PCC + FFP versus FFP alone for the treatment of COT.

Methods: We reviewed all trauma patients older than 18 years who received PCC + FFP or FFP alone at our Level I trauma center from 2015 to 2016. We excluded patients on preinjury oral anticoagulants. Patients were divided into two groups (4-PCC + FFP: FFP alone) and were matched in a 1:2 ratio using propensity score matching for demographics, vital and injury parameters, and initial international normalized ratio (INR). COT was defined as admission INR > 1.5. Corrected INR was defined as an INR of 1.5 or less. Outcome measures were time to correction of INR, packed red blood cells units transfused, thromboembolic complications, and mortality.

Results: We analyzed 516 trauma patients, of which 120 patients (4-PCC + FFP: 40, FFP: 80) were matched. Mean age was 58 ± 20 years; 60% were male, median Injury Severity Score was 29 (14-38). Mechanism of injury was blunt in 87% patients. 4-PCC + FFP was associated with an accelerated correction of INR (373 minutes vs. 955 minutes; p = 0.001), a decrease in packed red blood cells units (7 units vs. 9 units; p = 0.04), and FFP units (5 units vs. 7 units; p = 0.03) transfused compared to FFP alone. 4-PCC + FFP was associated with a lower mortality (25% vs. 33% p = 0.04) compared with FFP alone; however, there was no difference in the thromboembolic complications (2.5% vs. 1.2%, p = 0.5) between the two groups. Administration of PCC + FFP led to an earlier correction of the INR compared with FFP alone.

Conclusion: Results of our study demonstrated that the use of 4-PCC in conjunction with FFP is associated with the rapid reversal of INR and reduction in transfusion requirements as compared with FFP alone. Four-factor PCC as a component therapy along with FFP is superior to FFP alone for the reversal of COT.

Level of evidence: Therapeutic studies, level IV.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Disorders / therapy*
  • Blood Coagulation Factors / adverse effects
  • Blood Coagulation Factors / therapeutic use*
  • Female
  • Humans
  • International Normalized Ratio
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Plasma
  • Propensity Score
  • Retrospective Studies
  • Treatment Outcome
  • Wounds and Injuries / complications*


  • Blood Coagulation Factors
  • prothrombin complex concentrates