Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury.

@article{Grottke2011IncreasingCO,
  title={Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury.},
  author={Oliver Grottke and Till Braunschweig and Henri M. H. Spronk and Stephanie Esch and Annette D. Rieg and Ren{\'e} van Oerle and Hugo ten Cate and Christina Fitzner and Ren{\'e} H. Tolba and Rolf Rossaint},
  journal={Blood},
  year={2011},
  volume={118 7},
  pages={
          1943-51
        }
}
Despite increasing use of prothrombin complex concentrate (PCC) to treat hemorrhage-associated coagulopathy, few studies have investigated PCC in trauma, and there is a particular lack of safety data. This study was performed to evaluate PCC therapy in a porcine model of coagulopathy with blunt liver injury. Coagulopathy was induced in 27 anesthetized pigs by replacing approximately 70% blood volume with hydroxyethyl starch 130/0.4 and Ringer's lactate solution; erythrocytes were collected and… 
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Prothrombin complex concentrate reduces blood loss and enhances thrombin generation in a pig model with blunt liver injury under severe hypothermia.
TLDR
In severely hypothermic pigs, the application of PCC corrected trauma-induced coagulopathy and reduced blood loss and might be a reasonable approach to reduce the need for blood cell transfusion in trauma.
Recombinant human prothrombin (MEDI8111) combined with fibrinogen dose-dependently improved survival time and reduced blood loss in a porcine model of dilutional coagulopathy with uncontrolled bleeding
TLDR
The dose-dependent haemostatic improvement observed with MEDI8111 administration suggests that prothrombin concentration was rate limiting for coagulation.
Recombinant Factor VIIa Reduces Bleeding after Blunt Liver Injury in a Pig Model of Dilutional Coagulopathy under Severe Hypothermia
TLDR
Early administration of 90 μg/kg rFVIIa reduced blood loss in pigs undergoing blunt liver injury even after severe haemodilution and hypothermia, with no further effect of higher dose levels.
Re: Three versus four-factor prothrombin complex concentrates for "factor-based" resuscitation in a porcine hemorrhagic shock model.
  • O. Grottke
  • Medicine
    The journal of trauma and acute care surgery
  • 2018
TLDR
In an animal study, it was shown that PCC at a dose of 50 IU/kg after trauma and dilution coagulopathy led to protracted activation of coagulation, with thromboembolic complications and signs of disseminated intravascular coagULopathy.
Recombinant human prothrombin reduced blood loss in a porcine model of dilutional coagulopathy with uncontrolled bleeding
TLDR
RhFII decreased blood loss and improved hemostatic markers and survival and, coagulation time, maximum clot firmness, and prothrombin time improved in all groups.
Endogenous thrombin potential following hemostatic therapy with 4-factor prothrombin complex concentrate: a 7-day observational study of trauma patients
TLDR
Treatment with PCC increased ETP for several days, and patients receiving PCC therapy had low AT concentrations, implying a potential pro-thrombotic state not reflected by standard coagulation tests, although studies with clinical endpoints are needed to ascertain the implications for patient outcomes.
Three- versus four-factor prothrombin complex concentrates for “factor-based” resuscitation in a porcine hemorrhagic shock model
TLDR
PCC failed to correct coagulopathy and was associated with fibrinogen and platelet depletion, and these products should be used with caution in this setting.
Prothrombin Complex Concentrate Is Effective in Treating the Anticoagulant Effects of Dabigatran in a Porcine Polytrauma Model
TLDR
Four-factor PCC (50 or 100 U/kg) is effective in reducing blood loss in dabigatran-anticoagulated pigs, but higher doses may induce a procoagulant state.
Prothrombin Complex Concentrate-induced Disseminated Intravascular Coagulation Can Be Prevented by Coadministering Antithrombin in a Porcine Trauma Model.
TLDR
According to this trauma model, 50 IU/kg PCC increases the risk of disseminated intravascular coagulation and other thromboembolic complications, most notably when coadministered with fibrinogen concentrate, and the addition of antithrombin appears to reduce this risk.
Therapy with activated prothrombin complex concentrate is effective in reducing dabigatran-associated blood loss in a porcine polytrauma model.
TLDR
Blood loss following trauma in dabigatran-anticoagulated pigs was successfully reduced by 50 U/kg aPCC, as measured by several parameters including EXTEM clotting time (CT) and PT.
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