Perioperative prothrombin complex concentrate and fibrinogen administration are associated with thrombotic complications after liver transplant

Dehne, Sarah; Riede, Carlo; Klotz, Rosa; Sander, Anja; Feißt, Manuel; Merle, Uta; Mieth, Markus; Golriz, Mohammad; Mehrabi, Arianeb; Büchler, Markus W.; Weigand, Markus; Larmann, Jan

doi:10.3389/fmed.2022.1043674

Cited by 4 publications

(6 citation statements)

References 34 publications

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“…This is consistent with our fitted curve results, patients with long hospital stays tend to have longer surgical times, more severe disease, more comorbidities, poorer prognosis, and a higher risk of venous thrombosis. In addition, the use of PCC in the perioperative period of liver transplantation is independently associated with the primary composite endpoints of hepatic artery thrombosis, portal vein thrombosis, and inferior vena cava thrombosis ( 44 ). However, intraoperative use of PCC in cardiac surgery resulting in valve or vascular graft thrombosis has not been reported.…”

Section: Discussionmentioning

confidence: 99%

Association of prothrombin complexe concentrate with venous thrombosis after cardiac surgery: a case-control study

Zheng,

Zhang,

Liu

et al. 2023

Front. Cardiovasc. Med.

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BackgroundProthrombin complex concentrate (PCC) enhances coagulation and controls bleeding. We aimed to assess whether perioperative infusion of PCC is associated with venous thrombosis after cardiac surgery.MethodsWe conducted a case-control study of patients undergoing cardiac surgery at our hospital in 2021. Multivariate logistic regression was used to assess the correlation between perioperative PCC infusion and postoperative venous thrombosis in cardiac surgery. Stratified analysis was also performed by age, hospitalization days, and whether warfarin, warfarin combined with heparin, warfarin combined with antiplatelet drugs were used postoperatively.ResultsData from 161 patients undergoing cardiac surgery were included in the analysis. Of these, 37 (23.0%) patients in the case group developed venous thrombosis, and 124 (77.0%) patients in the control group did not develop venous thrombosis. In the analysis without adjustment for confounders (model 1), perioperative PCC infusion significantly increased the risk of postoperative venous thrombosis (OR: 3.10, 95% CI: 1.26–7.59, P = 0.0135). In the model analysis adjusted for sex, age, and hospitalization days (model 2), perioperative PCC infusion was no longer significantly associated with the risk of postoperative venous thrombosis (OR: 1.76, 95% CI: 0.56–7.59, P = 0.3317). In the fully adjusted model (model 3), there was a marginally significant association between perioperative infusion of PCC and the risk of postoperative venous thrombosis (OR: 0.03, 95% CI: 0.00–1.23, P = 0.0637).ConclusionsOur findings show no significant association between perioperative PCC infusion in cardiac surgery and the development of postoperative venous thrombosis. Randomized controlled trials are needed to determine the causal relationship between perioperative PCC infusion and venous thrombosis in cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Association of prothrombin complexe concentrate with venous thrombosis after cardiac surgery: a case-control study

Zheng,

Zhang,

Liu

et al. 2023

Front. Cardiovasc. Med.

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“…One of the major concerns for PCC use in surgical patients, including those undergoing LT, is thrombogenicity and potential for thromboembolic complications [ 3 , 13 , 14 ]. These complications may be increased by the patients’ underlying conditions, high or repeated dosing, coadministration of other hemostatic therapies, the presence of activated procoagulant factors, and poorly balanced procoagulant and anticoagulant proteins in PCCs.…”

Section: Rationale For Pcc Use In Lt Patientsmentioning

confidence: 99%

“…However, this finding was derived from a small number of retrospective studies and therefore should be interpreted with caution. More recently, in a single-center, retrospective study on 939 patients undergoing LT, PCC and FibC administration were independently associated with early onset of hepatic artery, portal vein, and/or inferior vena cava thrombosis within the first 30 days after surgery [ 3 ].…”

Section: Rationale For Pcc Use In Lt Patientsmentioning

confidence: 99%

“…Prothrombin complex concentrates (PCCs) are frequently used to correct coagulation abnormalities in patients with acute or chronic liver disease undergoing liver transplantation (LT) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. The main reason for this practice is the multiple advantages that PCC use might have in LT patients, particularly when compared to fresh frozen plasma (FFP) or other pro-coagulant drugs.…”

Section: Introductionmentioning

confidence: 99%

“…However, PCC use in LT patients may also increase the risk of thrombotic and thromboembolic events [ 3 , 13 , 14 ], which has not been systematically examined by previous investigations.…”

Section: Introductionmentioning

confidence: 99%

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Goal-Directed Use of Prothrombin Complex Concentrates in Liver Transplantation: Is a Plasma-Free Procedure Feasible?

Punzo,

Di Franco,

Aceto

2024

Hematology Reports

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Background: Fresh frozen plasma (FFP) transfusions have been the mainstay of hemostatic intervention for the treatment of bleeding and coagulation abnormalities arising during liver transplantation (LT) for decades. However, numerous clinical studies showed that FFP has many side effects, including the risk of pathogen transmission, transfusion-associated circulatory overload (TACO), transfusion-related immunomodulation (TRIM), and transfusion-related acute lung injury (TRALI). These adverse events are particularly challenging in patients undergoing LT, who often suffer from severe portal hypertension, poor renal function and coexisting cardiac disease.The aims of this review are to summarize the pharmacological properties of currently available PCCs, to represent the theoretical benefits and the possible risks related to the use of these drugs in patients undergoing LT, and, finally, to review the current literature on the topic in order to highlight the evidence that currently supports PCC use in LT patients. Methods: The current literature on the topic was reviewed in order to highlight the evidence that currently supports PCC use in LT patients. Results: Prothrombin complex concentrates (PCCs) may offer several advantages when compared to FFP. Indeed, PCCs have been shown to reduce the risk of TACO, which during liver transplantation may deteriorate portal hypertension, increase intraoperative bleeding, and possibly reduce survival rates. One of the major concerns for PCC use is thrombogenicity. However, currently available PCCs are much safer as they contain inactivated forms of the vitamin K-dependent coagulation factors and protein C, protein S, antithrombin and/or heparin. Nowadays, the use of PCCs to correct coagulation abnormalities that occur during LT is an increasingly widespread practice. However, it is not yet clear what level of evidence supports this practice, and what the risks associated with it are. Conclusions: Administration of PCC in LT patients to correct haemostatic abnormalities seems to be well-tolerated, but the relationship between PCC use and thromboembolic events in the postoperative period remains unclear. Adequately powered, methodologically sound trials are urgently required for more definitive conclusions about the efficacy and safety of PCCs in a broad phenotype of LT recipients.

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Tranexamic Acid Administration During Liver Transplantation Is Not Associated With Lower Blood Loss or With Reduced Utilization of Red Blood Cell Transfusion

Dehne,

Riede,

Feisst

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Current clinical guidelines recommend antifibrinolytic treatment for liver transplantation to reduce blood loss and transfusion utilization. However, the clinical relevance of fibrinolysis during liver transplantation is questionable, a benefit of tranexamic acid (TXA) in this context is not supported by sufficient evidence, and adverse effects are also conceivable. Therefore, we tested the hypothesis that use of TXA is associated with reduced blood loss. METHODS: We performed a retrospective cohort study on patients who underwent liver transplantation between 2004 and 2017 at Heidelberg University Hospital, Heidelberg, Germany. Univariable and multivariable linear regression analyses were used to determine the association between TXA administration and the primary end point intraoperative blood loss and the secondary end point intra- and postoperative red blood cell (RBC) transfusions. For further secondary outcome analyses, the time to the first occurrence of a composite end point of hepatic artery thrombosis, portal vein thrombosis, and thrombosis of the inferior vena cava were analyzed using a univariable and multivariable Cox proportional hazards model. RESULTS: Data from 779 transplantations were included in the final analysis. The median intraoperative blood loss was 3000 mL (1600–5500 mL). Intraoperative TXA administration occurred in 262 patients (33.6%) with an average dose of 1.4 ± 0.7 g and was not associated with intraoperative blood loss (regression coefficient B, −0.020 [−0.051 to 0.012], P = .226) or any of the secondary end points (intraoperative RBC transfusion; regression coefficient B, 0.023 [−0.006 to 0.053], P = .116), postoperative RBC transfusion (regression coefficient B, 0.007 [−0.032 to 0.046], P = .717), and occurrence of thrombosis (hazard ratio [HR], 1.110 [0.903–1.365], P = .321). CONCLUSIONS: Our data do not support the use of TXA during liver transplantation. Physicians should exercise caution and consider individual factors when deciding whether or not to administer TXA.

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Perioperative prothrombin complex concentrate and fibrinogen administration are associated with thrombotic complications after liver transplant

Cited by 4 publications

References 34 publications

Association of prothrombin complexe concentrate with venous thrombosis after cardiac surgery: a case-control study

Association of prothrombin complexe concentrate with venous thrombosis after cardiac surgery: a case-control study

Goal-Directed Use of Prothrombin Complex Concentrates in Liver Transplantation: Is a Plasma-Free Procedure Feasible?

Tranexamic Acid Administration During Liver Transplantation Is Not Associated With Lower Blood Loss or With Reduced Utilization of Red Blood Cell Transfusion

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