Influence of prothrombin complex concentrates on plasma coagulation in critically ill patients

Objective: To evaluate thrombogenicity of prothrombin complex concentrates (PCCs) in critically ill patients. Design: Prospective clinical study. Setting: Medical intensive care unit at a university hospital. Patients: 16 consecutive patients suffering from acquired deficiencies of c oagulation factors and with either overt bleeding from any site or a planne d invasive procedure. Interventions: 2000 factor IX units of PCCs intravenously. Measurements and results: Prothrombin time (PT), activated partial prothrom bin time, fibrinogen, platelet count, plasma levels of coagulation factors II, V, VII, VIII, IX, X, antithrombin, protein C, thrombin-antithrombin com plex (TAT), prothrombin fragment F1+2, and the fibrin degradation product D -dimer were measured prior to and 1, 3, and 24 h after administration of PC Cs. PT as well as coagulation factors II, VII, IX, and X, TAT, and F1+2 sho wed a significant increase after administration of PCCs. All other paramete rs remained unchanged. Conclusions: Administration of PCCs induces thrombin generation. No evidenc e for induction of disseminated intravascular coagulation in biochemical te rms could be found. When rapid correction of acquired coagulation factor di sturbances is warranted, the use of PCCs seems reasonable, but the elevated risk of intravascular thrombus formation should be kept in mind.