Comparison of blood product use and costs with use of 3-factor versus 4-factor prothrombin complex concentrate for off-label indications.

PURPOSE: Results of a comparison of blood product use and cost outcomes with use of 3-factor versus 4-factor prothrombin complex concentrate (PCC) for indications other than warfarin reversal are presented. METHODS: Consecutive patients who received 3-factor PPC (PCC3) or 4-factor PCC (PCC4) for non-warfarin-related indications at 2 U.S. hospitals during a 19-month period were identified. The primary outcome was in-hospital blood product use, with a focus on plasma use. Total hemostasis costs, intensive care unit (ICU) and hospital lengths of stay, and other outcomes were evaluated. RESULTS: Indications for PCC3 use (n = 118) or PCC4 use (n = 64) included intraoperative bleeding, nonintraoperative bleeding, coagulopathy of liver disease, and reversal of direct-acting oral anticoagulant effects. The proportion of patients who received plasma was 56.8% with PCC3 use versus 53.1% with PCC4 use (p = 0.643); the corresponding median volumes of plasma received were 638 mL (interquartile range [IQR], 550-1,355 mL) and 656 mL (IQR, 532-1,136 mL), respectively. The median total hemostasis costs were $5,559 (IQR, $3,922-$8,159) with PCC3 use and $7,771 (IQR, $6,366-$9,205) with PCC4 use (p < 0.001). CONCLUSION: PCC3 use and PCC4 use were associated with similar blood product use, ICU length of stay, hospital length of stay, and in-hospital mortality when given for non-warfarin-related indications. However, relative to PCC3 use, PCC4 use was associated with an increase in costs that was primarily due to drug costs.

A study on the efficacy of a phospholipid solution in dogs with aspirin-induced thrombocytopathy.

The aim of the present study was to test the haemostyptic properties of a phospholipid complex with platelet factor-3 (PF-3) activity in platelet-dependent haemostatic disorders. The substance was investigated in an animal model comprising six investigational groups (five dogs each). A thrombocytopathy was created in the dogs belonging to groups 1-5 by intravenous administration of 20 mg/kg body weight (BW) acetylsalicylic acid (ASA). Two hours later a human albumin solution (5%) (control group) or a phospholipid complex with PF-3 activity was injected or infused intravenously in different dosages. In dogs pre-treated with ASA, injection of 2 ml/kg BW of the phospholipid complex shortened capillary bleeding time, which was prolonged as a consequence of ASA-treatment. This effect lasted for 4 h at least. The capability of the platelets to aggregate increased 5 min after intravenous injection of the phospholipid without differences in the respective groups. At the same time platelet counts dropped to approximately 50%, but increased again distinctly after 30 min. When the phospholipid complex was administered to clinically healthy dogs who had not been treated with ASA, this resulted in prolongation of the capillary bleeding time as well as a significant platelet drop in the peripheral blood. Although these were only short-term effects after administration of the phospholipid complex, a disadvantageous effect cannot be excluded in patients suffering from haemorrhagic diathesis. For this reason, a phospholipid complex with PF-3 activity cannot be recommended as a therapeutic agent for platelet-dependent coagulation disorders in the dog.

[The treatment of haemorrhagic complications due to disturbance of platelet function after operations with extracorporal circulation (author's transl)]. / Therapie thrombozytärer Blutungen nach Eingriffen mit extrakorporaler Zirkulation.

The preoperative selective blood cell separation followed by the postoperative platelet autoransfusion could prevent the exhaustion of platelet function by operations with extracorporal circulation. The postoperative blood loss could be reduced by about 57%. This method can be recommended specially in cases of increased platelet traumatization after long time perfusion. Partial disturbances of platelet function after operations with ECC can also be favourably influenced by infusion of homologous phospholipid (Fibraccel). The postoperative blood loss could be reduced by about one third. This method is beneficial in open heart surgery with short perfusion times due to its little technical expenses.