Comparison of drug administration logistics between prothrombin complex concentrates and plasma in the emergency department

Background: Prothrombin complex concentrate (PCC) is used as an alternative to fresh frozen plasma (FFP) for emergency bleeding. The primary objective of this study was to compare the time from order to start of administration between 3-factor PCC (PCC3), 4-factor (PCC4), and FFP in the emergency department (ED). The secondary objective was to evaluate the effect of an ED pharmacist on time to administration of PCCs. Methods: This was a single center three-arm retrospective cohort study. Adult patients in the ED with bleeding were included. The primary outcome measure was the time from order to administration, which was compared between PCC3, PCC4, and FFP. The time from order to administration was also compared when the ED pharmacist was involved versus not involved in the care of patients receiving PCC. Results: There were 90 patients included in the study cohort (30 in each group). The median age was 69 years (IQR 57–82 years), and 57% (n = 52) were male. The median time from order to administration was 36 min (IQR 20–58 min) for PCC3, 34 min (IQR 18–48 min) for PCC4, and 92 min (IQR 63–133) for FFP (PCC3 versus PCC4, p = 0.429; PCC3 versus FFP, p < 0.001; PCC4 versus FFP, p < 0.001). The median time from order to administration was significantly decreased when the ED pharmacist was involved (24 min [IQR 15–35 min] versus 42 min [IQR 32–59 min], p < 0.001). Conclusions: Time from order to administration is faster with PCC than FFP. ED pharmacist involvement decreases the time from order to administration of PCC.