Effectiveness of prothrombin complex concentrate for the treatment of bleeding: A systematic review and meta-analysis


Abstract

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.

Keywords: bleeding; blood coagulation factors; hemostasis; meta-analysis; prothrombin complex concentrate; systematic review.

Conflict of interest statement

None.

Figures

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PRISMA flow diagram search strategy
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FIGURE 2
Forest plot comparison of overall and subgroup mortality in patients treated with PCC vs patients not treated with PCC
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Forest plot comparison of blood loss in cardiac surgery patients treated with PCC vs patients not treated with PCC
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Forest plot comparison of overall and subgroup RBC utilization in patients treated with PCC vs patients not treated with PCC
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FIGURE 5
Forest plot comparison of overall and subgroup thromboembolic events in patients treated with PCC vs patients not treated with PCC
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