Background The use of whole blood (WB) for the treatment of hemorrhagic shock and coagulopathy is increasing in civilian trauma patients. Four-factor prothrombin complex concentrate (4-PCC) in adjunct to component therapy showed improved outcomes in trauma patients. Our study aims to evaluate the outcomes of trauma patients who received 4-PCC+WB compared to WB alone. Methods We performed a three-year (2015-2017) analysis of the American College of Surgeons-Trauma Quality Improvement Program database. All adult (age ≥18 years) trauma patients who received WB were included. We excluded patients who were on preinjury anticoagulants. Patients were stratified into two groups: 4-PCC+WB versus WB alone, and matched in a 1:2 ratio using propensity score matching. Outcome measures were packed red blood cells, plasma, platelets, and cryoprecipitate transfused, in-hospital complications, hospital and ICU length of stay (LOS) among survivors, and mortality. Results A total of 252 patients (4-PCC+WB, 84; WB alone, 168) were matched. Mean age was 47±21 years; 63% were males; median injury severity score was 30 [21–40], and 87% had blunt injuries. Patients who received 4-PCC+WB had decreased requirement for pRBC (8 units vs. 10 units; p=0.04) and FFP (6 units vs. 8 units; p=0.01) transfusion, lower rates of acute kidney injury (p=0.03), and ICU LOS (5 days vs. 8 days, p=0.01) compared to WB alone. There was no difference in the platelet transfusion (p=0.19), cryoprecipitate transfusion (p=0.37), hospital LOS (p=0.72), and in-hospital mortality (p=0.72) between the two groups. Conclusion Our study demonstrates that the use of 4-PCC as an adjunct to WB is associated with a reduction in transfusion requirements and ICU LOS compared to WB alone in the resuscitation of trauma patients. Further studies are required to evaluate the role of PCC with WB in the resuscitation of trauma patients. Level of Evidence Level III Therapeutic Oral Podium Presentation: 34th EAST Annual Scientific Assembly that will be held virtually on January 13-14, 2021 There are no identifiable conflicts of interest to report. The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript. Address for correspondence: Bellal Joseph, MD, FACS, University of Arizona, Department of Surgery Division of Trauma, Critical Care, And Emergency Surgery, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ 85724 Email: bjoseph@surgery.arizona.edu Tel: 520-626-5056 Fax: 520-626-5016 © 2021 Lippincott Williams & Wilkins, Inc.
