Original ArticleComparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery
Introduction
Coronary artery bypass grafting (CABG) is frequently complicated by significant perioperative bleeding, with prognostic implications [1]. Coagulopathy occurring after cardiac surgery is a multifactorial and poorly understood condition [2], [3], [4], which is often treated by administrating fresh frozen plasma (FFP) as this allows replacement of most coagulation factors, including fibrinogen [5]. However, administration of FFP is associated with a risk of transmission of viral, bacterial, parasitic as well as prion diseases, febrile and allergic reactions, transfusion-associated circulatory overload, transfusion-related acute lung injury, acute haemolytic transfusion reactions in addition to ABO blood group incompatibility [5], [6]. Prothrombin complex concentrate (PCC) has been proposed as a potential valid alternative to FFP in patients with excessive bleeding after cardiac surgery [7], [8], [9], [10] and this issue had been investigated in this study.
Section snippets
Methods
The E-CABG registry (European Multicenter Study on Coronary Artery Bypass Grafting) (Clinical Trials Identifier NCT02319083) is a prospective, multicentre study that enrolled patients undergoing isolated CABG from Finland, France, Italy, Germany, Sweden and United Kingdom. The detailed protocol and definition criteria have been previously published [11]. The study was approved by the Institutional Review Board of the participating centres.
The study cohorts consisted of patients who received
Overall Series
Among 7,118 consecutive patients operated at 15 centres from January 2015 to December 2016, 416 patients received postoperatively only FFP and 119 patients received PCC with or without FFP (Table 1). Prothrombin complex concentrate was used in 9 out of 15 centres and one of these centres used only PCC.
Mixed-effects regression analyses adjusted for multiple covariate and participating centres showed that the use of PCC was associated with significantly lower risk of RBC transfusion (67.2% vs.
Discussion
This study showed that several European centres of cardiac surgery started to adopt PCC as an alternative to FFP in patients with postoperative coagulopathy after isolated CABG and this policy seems to be associated with a significant reduction in RBC and platelet transfusion requirements. A risk reduction for RBC and platelet transfusion was observed both in mixed-effect logistic regression and propensity score matched analyses (Table 2). These statistical approaches showed that chest drain
Conclusions
These results suggest that the use of PCC compared with FFP may reduce the need of blood transfusion after CABG. In view of the observational nature of this study, these results should be considered hypothesis generating and need to be confirmed in randomised trials.
Conflict of Interest
None.
Financial Support
This study was not financially supported.
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Cited by (17)
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2022, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Despite a significantly higher volume of transfused blood products registered in the blood product–based management group, these patients experienced more blood loss than the subjects in the FC group. Whereas previous investigations—both retrospective and randomized—could not present better postoperative mortality related to fibrinogen concentrate or PCC compared with FFP treatment, the authors revealed a greater than 13-fold decrease in the odds of early postoperative death when perioperative bleeding was treated with FC instead of blood product–based management.13,23,25,26,28,29 In the meta-analysis of Li et al.14 a definitive advantage of fibrinogen concentrate treatment for reduction in risk of mortality or other outcome parameters including postoperative blood loss has not been confirmed compared with controls.
Roles of Four-Factor Prothrombin Complex Concentrate in the Management of Critical Bleeding
2021, Transfusion Medicine ReviewsCitation Excerpt :The resulting reduced cardiopulmonary reserve and preexisting hemostatic dysfunction make CS patients prone to post-CPB hemodynamic instability, bleeding, and transfusion-related complications, resulting in prolonged mechanical ventilation and increased length of intensive care unit stay, increased risks of re-exploration due to bleeding, transfusion-associated circulatory overload (TACO), acute lung injury, infection, and other end-organ injuries [10-12]. In the CS setting, PCCs have been often used as an adjunct to standard coagulation therapies [10,11,13,14], but it is yet to be proven if the use of FP could be substituted by 4F-PCC in complex CPB cases. Karkouti et al. recently tried to answer this question by conducting a pilot prospective randomized trial (PRT) of 4F-PCC (Octapharma AG, Lachen, Switzerland) versus FP transfusion in bleeding CS patients at two Canadian teaching hospitals in Toronto [15].
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2020, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :No beneficial effects of PCC administration were found for secondary outcomes, including chest tube drainage, in-hospital mortality, stroke, or acute kidney injury. The study's main result, reduced RBC transfusion, is consistent with an international, prospective multicenter study (n = 416), which showed a reduced need for RBC transfusion in patients treated with PCC compared with FFP (OR 0.319 [95% CI 0.136-0.752]).68 The results regarding postoperative acute kidney injury differ somewhat between the 2 studies.
Hemostasis Using Prothrombin Complex Concentrate in Patients Undergoing Cardiac Surgery: Systematic Review with Meta-Analysis
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