Administration of fibrinogen concentrate combined with prothrombin complex maintains hemostasis in children undergoing congenital heart repair (a long‐term propensity score‐matched study)

Abstract

Background Bleeding is a common problem in children with congenital heart disease undergoing major cardiac surgery requiring cardiopulmonary bypass (CPB). Little is known about optimal management with blood products. Objective To investigate clinical outcome and hemostatic effects of fibrinogen concentrate (FC) in combination with prothrombin complex concentrate (PCC) versus standard treatment with fresh frozen plasma (FFP) in children undergoing cardiac surgery. Methods For this single‐institution cohort study, data on 525 children were analyzed. Propensity score matching in 210 children was applied to reduce the impact of various baseline characteristics. Results Three children treated with FC/PCC developed surgical site bleeding requiring surgical revision. One child developed central venous line‐related thrombosis. Blood loss through chest tube drainage was independent of FC/PCC. Coagulation abnormalities were not present in any of these children. Time to extubation and ICU stay did not differ. In the FC/PCC group, children received (median, Q1, Q3) 52 mg/kg (32, 83) FC and 28IU/kg (13, 44) PCC. Fibrinogen concentration was comparable at baseline. On admission to the ICU, fibrinogen was higher in children receiving FC/PCC, namely, 232 mg/dL (196, 280), than in children receiving FFP (186 mg/dL, 149, 224; P < .001). On discharge from the ICU, values did not differ ((FC/PCC 416 mg/dL (288, 501)), non‐FC/PCC 418 mg/dL (272, 585; P = 1.000)). Conclusion FC/PCC was well tolerated and permitted hemostasis to be maintained, even in the very young. We were not able to detect a signal for inferiority of this treatment. We conclude that FC/PCC can safely replace FFP.

Activated 4-Factor Prothrombin Complex Concentrate as a Hemostatic Adjunct for Neonatal Cardiac Surgery: A Propensity Score-Matched Cohort Study

“…This is consistent with the other publications reporting the use of PCCs in both pediatric cardiac surgery and adult cardiac surgery. 5–10 The overall incidence of postoperative thromboembolism in our cohort of 165 neonates with a rate of 7.3% and 13.3% at POD 7 and 30, respectively, is consistent with the rate reported from other neonatal studies ranging from 9% to 30%. 14,15,22…”

Efficacy and Safety of Minimally Invasive Transcatheter Closure of Congenital Heart Disease under the Guidance of Transesophageal Ultrasound: A Randomized Controlled Trial

“…The traditional surgical treatment of VSD and ASD is mainly direct vision repair of cardiac septal defect under CPB. With the increasing number of clinical cases of complex CHD, some traditional surgical treatments, especially in children with VSD, are subject to various limitations [ 13 ]. Moreover, conventional thoracotomy for open heart defect repair has the advantages of large trauma, long operation time, many postoperative complications, long hospitalization cycle, and high medical cost, which has been gradually eliminated in the treatment of simple CHD.…”

Coagulation and Transfusion Updates From 2021

“…A recent single-center investigation, combining fibrinogen concentrates and PCC, was performed in patients undergoing surgery for congenital heart disease. 40 This combination was well-tolerated and allowed for adequate hemostasis when compared to standard treatment with FFP alone. Another study examined the value of adding factor XIII concentrates to fibrinogen concentrates in treating coagulopathy.…”