• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Three Versus Four-Factor Prothrombin Complex Concentrates for “Factor-Based” Resuscitation in a Porcine Hemorrhagic Shock Model

Donald Moe, MD, Michael Lallemand, MD, John McClellan, MD, Joshua Smith, DO, Shannon Marko, DVM, Matthew Eckert, MD, Matthew Martin, MD. Madigan Army Medical Center

Objectives: Bleeding remains the leading cause of preventable death following severe injury. Prothrombin complex concentrates (PCC) treat inborn coagulation disorders and reverse vitamin-K antagonists, but are proposed for use in “factor-based” resuscitation strategies and in austere/military environments. There is a paucity of controlled studies for this indication, or that compare 3-factor (3PCC) versus 4-factor (4PCC) products. We aimed to assess and compare their safety and efficacy in a porcine model of severe hemorrhagic shock and coagulopathy.

Methods: 25 adult Yorkshire swine underwent 35% volume hemorrhage, an ischemia-reperfusion injury and protocolized resuscitation to produce dilutional coagulopathy. 17 animals were randomized at 4-hours following model creation to receive a 45 IU/kg dose of either 3PCC or 4PCC. In order to better characterize PCC use in trauma, following interim analysis an additional 8 animals received 4PCC with the addition of fresh plasma transfusion. Individual factor levels were drawn at 4 and 6 hours.

Results: The model created significant physiologic derangement with hematocrit of 16, pH of 7.21, and a lactate of 9.6. Following administration of PCC, 66.7% of 3PCC animals and 25% of 4PCC animals (regardless of plasma administration) developed disseminated intravascular coagulation (DIC). Prior to PCC the animals developing DIC had manifested the "lethal triad" with significantly lower temperatures (97.4°F vs 100°F), greater degrees of acidosis (pH 7.14 vs 7.27), and coagulopathy (INR 1.47 vs 1.19, all P<0.05). Fibrinogen levels prior to PCC administration correlated significantly with development of DIC [Figure]. In the absence of DIC when compared with controls, both 3PCC and 4 PCC, again regardless of plasma administration, transiently improve prothrombin time and individual clotting factors [Figure]. Despite the improvement in individual factors, there was significant depletion of fibrinogen and platelets with no lasting improvement of coagulopathy.

Conclusion: In a severe hemorrhagic shock model PCC successfully replaced individual clotting factors, but was associated with fibrinogen depletion and failure to correct coagulopathy. Of greater concern, PCC administration in this setting resulted in rapid onset DIC in the more severely ill animals. The incidence of DIC was markedly increased with 3PCC versus 4PCC, and these products should be used with caution in this setting.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80684

Program Number: MSS21

Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations

Presentation Type: MSSPodium

66

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons