Elsevier

Heart, Lung and Circulation

Volume 28, Issue 12, December 2019, Pages 1881-1887
Heart, Lung and Circulation

Original Article
Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery

https://doi.org/10.1016/j.hlc.2018.10.025Get rights and content

Background

Recent studies suggested that prothrombin complex concentrate (PCC) might be more effective than fresh frozen plasma (FFP) to reduce red blood cell (RBC) transfusion requirement after cardiac surgery.

Methods

This is a comparative analysis of 416 patients who received FFP postoperatively and 119 patients who received PCC with or without FFP after isolated coronary artery bypass grafting (CABG).

Results

Mixed-effects regression analyses adjusted for multiple covariates and participating centres showed that PCC significantly decreased RBC transfusion (67.2% vs. 87.5%, adjusted OR 0.319, 95%CI 0.136–0.752) and platelet transfusion requirements (11.8% vs. 45.2%, adjusted OR 0.238, 95%CI 0.097–0.566) compared with FFP. The PCC cohort received a mean of 2.7 ± 3.7 (median, 2.0, IQR 4) units of RBC and the FFP cohort received a mean of 4.9 ± 6.3 (median, 3.0, IQR 4) units of RBC (adjusted coefficient, -1.926, 95%CI -3.357–0.494). The use of PCC increased the risk of KDIGO (Kidney Disease: Improving Global Outcomes) acute kidney injury (41.4% vs. 28.2%, adjusted OR 2.300, 1.203–4.400), but not of KDIGO acute kidney injury stage 3 (6.0% vs. 8.0%, OR 0.850, 95%CI 0.258–2.796) when compared with the FFP cohort.

Conclusions

These results suggest that the use of PCC compared with FFP may reduce the need of blood transfusion after CABG.

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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