LAUSR

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Four factor PCC is recommended for intracranial hemorrhage (ICH) associated with vitamin k antagonist. Limited data exists supporting off-labeled indications and outcomes. This study evaluated the impact of criteria compliance with PCC on blood product administration. Methods: This retrospective cohort study evaluated patients who received PCC from 5/20156/2016. Patients were excluded if age < 18 years or palliative care or DNR within 24 hours of PCC. Institution specific criteria for appropriate PCC use included reversal of vitamin K antagonist or DTI or concomitantly with a massive transfusion protocol. All cases were evaluated for appropriateness based on PCC criteria and compared as appropriate (A) vs inappropriate (IA) for statistical significance. Results: During the study,766 adult patients received PCC with 299 meeting inclusion criteria (188 A vs 111 IA). Mean age was 68.8 ± 14.5 years and 56% were male. The most common reason for inappropriate PCC use was coagulopathy(69%) & trauma (25%). More blood products (PRBC, FFP, platelets, and cryoprecipitate) were more likely to be used for the IA group(all p < 0.01). IA group required more hemostatic agent administration which included aminocaproic acid, desmopressin, or protamine, 48% IA vs 8% A, p < 0.007. However, time from PCC administration to INR < 1.5 was not different,12.7 ± 10.4 IA vs 13.0 ± 8.2 A, hours, p = 0.90. In-hospital mortality was higher for the IA group,41% IA vs 24% A, p = 0.004. The PCC dose was lower for IA use, 26 ± 8 IA vs 31 ± 10 A, mg/kg, p < 0.001 with vial size rounding. Thrombosis rates were not different. Hospital & ICU LOS in surviving patients were longer with IA,17.7 ± 16.3 IV vs 9.1 ± 9.6 A, days, p < 0.001, & 10.8 ± 13.5 IA vs 5.2 ± 7.4 A, days, p < 0.001, respectively. Conclusions: This cohort of pts revealed high rates of inappropriate PCC use based on institutional criteria. Inappropriate pts required more blood products & adjunct hemostatic agents suggesting PCC being used in pts with high rates of mortality likely due to irreversible causes. Evaluation & adherence to criteria may decrease healthcare resources.