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.