Prothrombin complex concentrate (Beriplex P/N) for control of bleeding after kidney trauma in a rabbit dilutional coagulopathy model☆

Abstract 

Introduction

Fluid resuscitation after trauma often results in dilutional coagulopathy that may hinder control of bleeding and, once initial hemostasis has been secured, heighten risk of perioperative bleeding when further surgery is required. Since multiple coagulation factor deficiencies typically accompany fluid resuscitation, prothrombin complex concentrate (PCC) containing factors II, VII, IX and X may potentially offer greater hemostatic efficacy than coagulation factor monotherapy.

Materials and methods

Anesthetized normothermic rabbits were hemodiluted 50-60% by phased blood withdrawal and infusion of hydroxyethyl starch and erythrocytes. The animals were randomly assigned to receive saline placebo, 25IU·kg^-1 PCC (Beriplex P/N) or 180μg·kg^-1 activated recombinant factor VII (rFVIIa; NovoSeven). Immediately thereafter, bleeding was precipitated by a standardized kidney incision.

Results

PCC accelerated hemostasis compared both with saline and rFVIIa (p=0.002 for both comparisons). The median times to hemostasis in the PCC, saline and rFVIIa groups were 12, 19 and 28min, respectively. PCC reduced blood loss by a median of 43mL with a 95% confidence interval (CI) of 8.0-67.5mL vs. saline and 82mL (CI, 35.0-110.0mL) vs. rFVIIa. PCC augmented peak thrombin generation by a median of 104.1 nM (CI, 78.3-142.3 nM) compared with saline and 105.8 nM (CI, 70.7-139.5 nM ) relative to rFVIIa. At the respective 180μg·kg^-1 and 25IU·kg^-1 doses tested, rFVIIa displayed thrombogenicity in the Wessler stasis model, while PCC did not.

Conclusions

In an animal model of dilutional coagulopathy and kidney trauma, PCC accelerated hemostasis and diminished blood loss compared with rFVIIa monotherapy.

Abbreviations: CI, 95% confidence interval, FII, factor II, FVII, factor VII, FIX, factor IX, FX, factor X, HES, hydroxyethyl starch, IQR, interquartile range, PCC, prothrombin complex concentrate, PT, prothrombin time, rFVIIa, recombinant factor VIIa

Keywords: Prothrombin complex concentrate, Recombinant factor VIIa, Trauma, Blood coagulation disorders, Hemorrhage, Models, animal