Four‐factor prothrombin complex concentrate in pediatric cardiac surgery for children under 8 kg: A short report

Dosing, Monitoring, Blood Product Utilization, and Thromboembolic Complications of Four-Factor Prothrombin Complex Concentrate as Part of an Institutional Protocol in Pediatric Cardiac Surgery: A Retrospective Cohort Study

“…24 Cruz-Suárez et al reported that among 48 pediatric patients undergoing CPB, 1 patient was found during follow-up to have sinus venous thrombosis, and another patient was noted to have an intracerebral hemorrhage. 23 In our study, two patients developed a thrombotic complication within 30 days of 4F-PCC administration. The first patient developed biventricular intracardiac thrombosis 1 day postoperatively.…”

“…We found that the rate of thromboembolism during the surgical encounter of 2% was similar to other smaller studies that included 5 to 15 patients and that reported no thrombotic events. [21][22][23][24] Limitations of the present study include its retrospective design from a single site, which may limit generalizability of the findings. While there was no control group for the analysis of study outcomes such as length of stay, we were able to compare values of pre-/post-4F-PCC administration.…”

“…While the design of this study did not compare patients who received 4F-PCC to those who did not, the reported chest tube output and blood product transfusion in the postoperative setting are less than those reported in other pediatric cardiac surgery studies. [21][22][23][24][25][27][28][29][30][31] Bleeding is a common issue in pediatric patients undergoing cardiac surgery requiring CPB, and the lack of standard guidelines often results in utilization of a wide variety of blood products. Mechanisms contributing to excessive bleeding following CPB include heparinization, hemodilution through circuit prime, hypothermia, as well as interactions between the coagulation and inflammatory systems.…”

“…21 Additional case reports and studies describe the use of PCC in pediatric cardiac surgery to prevent or control bleeding. [22][23][24] Due to the lack of evidence on the use of PCC in relatively larger cohorts, the objective of this study was to describe dosing, monitoring, blood product utilization, and thromboembolic complications following the use of 4F-PCC among a cohort of 86 patients undergoing cardiac surgery.…”