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Review
. 2023 Jun;33(3):205-212.
doi: 10.1111/tme.12969. Epub 2023 Mar 20.

The use of prothrombin complex concentrate in chronic liver disease: A review of the literature

Marie-Astrid van Dievoet  1   2 , Xavier Stephenne  2   3 , Madeleine Rousseaux  1 , Ton Lisman  4 , Cedric Hermans  5 , Véronique Deneys  1
Affiliations
Review

The use of prothrombin complex concentrate in chronic liver disease: A review of the literature

Marie-Astrid van Dievoet et al. Transfus Med. 2023 Jun.

Abstract

Patients with chronic liver disease (CLD) and cirrhosis present a rebalanced hemostatic system in the three phases of haemostasis. This balance is however unstable and can easily tip towards bleeding or thrombosis. Management of both spontaneous bleeding and bleeding during invasive procedures remains a challenge in this patient population. Transfusion of blood products can result in circulatory overload and thereby worsen portal hypertension. As an alternative to fresh frozen plasma (FFP), prothrombin complex concentrates (PCC) may have merit in patients with liver disease because of their low volume. The impact of PCC in in-vitro spiking experiments of cirrhotic plasma is promising, but also warrants cautious use in light of thromboembolic risk. The majority of existing studies carried-out in CLD patients are retrospective or do not have an adequate control arm. A prospective study (the PROTON trial) was set up in 2013 to investigate the utility of PCC in patients undergoing liver transplantation. However, the study has never recruited the planned number of patients. Robust data on PCC safety in CLD is also required. The limited existing evidence does not seem to indicate an excessive thromboembolic risk. Currently, the utilisation of PCC in CLD cannot be routinely recommended but can provide an option for carefully selected cases in which other measures were not sufficient to control bleeding and after delicately weighing risks and benefits.

Keywords: bleeding; chronic liver disease; cirrhosis; prothrombin complex concentrate; thromboembolic risk.

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References

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