Effect of PCC on outcomes of severe traumatic brain injury patients on preinjury anticoagulation

Introduction: This study aims to evaluate effect of 4-factor PCC on outcomes of severe TBI patients on preinjury anticoagulants undergoing craniotomy/craniectomy. Methods: In this analysis of 2018–2020 ACS-TQIP, patients with isolated blunt severe TBI (Head-AIS≥3, nonhead-AIS<2) using preinjury anticoagulants who underwent craniotomy/craniectomy were identified and stratified into PCC and No-PCC groups. Outcomes were time to surgery and mortality. Multivariable binary logistic and linear regression analyses were performed. Results: 1598 patients were identified (PCC-107[7 %], No-PCC-1491[93 %]). Mean age was 74(11) years, 65 % were male, median head AIS was 4. Median time to PCC administration was 109 ​min. On univariable analysis, PCC group had shorter time to surgery (PCC-341, No-PCC-620 ​min, p ​= ​0.002), but higher mortality (PCC35 %, No-PCC21 %,p ​= ​0.001). On regression analysis, PCC was independently associated with shorter time to surgery (β ​= ​−1934,95 %CI ​= ​−3339to-26), but not mortality (aOR ​= ​0.70,95 %CI ​= ​0.14–3.62). Conclusion: PCC may be a safe adjunct for urgent reversal of coagulopathy in TBI patients using preinjury anticoagulants.