Comparing Three Eras of Hepatic Coagulopathy Normalization Using Coagulation Factor Concentrates

Objective: To evaluate the efficacy and safety of three different normalization strategies utilizing coagulation factor concentrates (CFCs) in patients with hepatic coagulopathy of either acute or chronic etiology experiencing a life-threatening bleed or need for normalization of coagulopathy prior to invasive procedure. Design: Retrospective analysis. Setting: University-affiliated academic medical center. Patients: Adult patients admitted with hepatic dysfunction who received CFC for treatment of an active bleed or to normalize coagulopathy prior to an invasive procedure. Interventions: None. Measurements and main results: Patients were stratified into three treatment groups dependent upon which CFC was administered: recombinant factor VIIa (rfVIIa), three factor prothrombin complex concentrate (3F-PCC)/rfVIIa, or four factor prothrombin complex concentrate (4F-PCC). Fifty patients were included who received rfVIIa (n=19, 38%), 3F-PCC/rfVIIa (n=9, 18%), or 4F-PCC (n=22, 44%) during the study period. The groups were well-matched regarding age, weight, sex, hospital and ICU length of stay, baseline coagulation labs, and characteristics of liver dysfunction. All patients in the rfVIIa and 3F-PCC/rfVIIa groups achieved an INR <1.6 within four hours of first CFC use. Eight patients (36.4%) in the 4F-PCC group met the same endpoint within four hours of administration. Transfusion requirements did not differ before and after CFC administration in all groups. TE complications occurred in eight (16%) patients. Conclusions: CFCs appear to be effective for the normalization of INR in patients with hepatic coagulopathy in the setting of active bleeding or prior to invasive procedures.