Use of prothrombin complex concentrate for management of coagulopathy after cardiac surgery: a propensity score matched comparison to plasma

Fitzgerald, John; Lenihan, Martin; Callum, Jeannie; McCluskey, Stuart A.; Srinivas, Coimbatore; Rensburg, Adriaan Van; Karkouti, Keyvan

doi:10.1016/j.bja.2018.02.017

Cited by 49 publications

(63 citation statements)

References 26 publications

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“…Fitzgerald et al retrospectively reviewed patients who received PCCs undergoing cardiac surgery with CPB in a propensity score matched comparison with those who received FFP and found that the odds ratio for red cell avoidance was 2.4 (95% CI: 0.24-1.03) for the PCC group. 51 Those who received PCCs also had lower incidence of massive transfusion and refractory bleeding.…”

Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

Hemostatic Management of Extracorporeal Circuits Including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation

Fang

Navaei

Hensch

et al. 2019

Semin Thromb Hemost

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Cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO) cause hemostatic derangements that can predispose patients to both bleeding and thrombotic complications. Often, patients present for urgent surgery while taking medications including antiplatelet agents, vitamin K antagonists, and direct oral anticoagulants, which must be recognized, monitored, and managed. During extracorporeal circulation, appropriate anticoagulation, most commonly with heparin, is required to maintain blood flow and avoid thrombotic complications. However, anticoagulation and other effects of extracorporeal circuits can also have an undesired consequence of bleeding. Extracorporeal circulation leads to coagulopathy that may require therapy with blood products such as platelets, cryoprecipitate, and plasma in case a patient bleeds. Platelet dysfunction related to exposure to a foreign circuit is a primary concern, as is the development of acquired von Willebrand syndrome, which frequently remains undetected on routine testing. Hemorrhagic complications in ECMO, such as intracranial hemorrhage, pulmonary hemorrhage, and hemithorax, can occur. Hemostatic agents including antifibrinolytics, desmopressin, fibrinogen concentrates, and other factor concentrates may be needed to achieve hemostasis in these often-challenging patients. Managing bleeding on extracorporeal support requires careful monitoring and a thoughtful approach.

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Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

Hemostatic Management of Extracorporeal Circuits Including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation

Fang

Navaei

Hensch

et al. 2019

Semin Thromb Hemost

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“…[97][98][99] In patients requiring urgent operations, reversal of vitamin K antagonists was more effective with prothrombin complex concentrates (PCC) compared with FFP, mainly because of a more rapid hemostatic effect. 100 Several studies [101][102][103][104] have reported that administration of PCC is also more effective than FFP in CPB-related coagulopathic bleeding and leads to decreased postoperative bleeding and transfusion. However, concerns regarding increased risk for postoperative acute kidney injury have been raised in one study.…”

Section: Rbc Transfusion and Use Of Cell Salvagementioning

confidence: 99%

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Raphael

Mazer

Subramani

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

100

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Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point of care coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, has increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has declined only modestly over the last decade, remaining at 50% or greater in high-risk patients. Given these limitations and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists has formed the Blood Conservation in Cardiac Surgery Working Group in order to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.

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“…It should be noted that this is also true for traditional blood components, such as platelets and plasma. There is growing evidence showing the benefits of PCCs for patients with decreased thrombin generation outside of VKA reversal, such as in cardiac surgery . In contrast, in the United States, the available four‐factor PCC is exclusively approved for urgent reversal of VKA therapy, not other acquired deficiencies …”

Section: Pccsmentioning

confidence: 99%

“…There is growing evidence showing the benefits of PCCs for patients with decreased thrombin generation outside of VKA reversal, such as in cardiac surgery. 12 In contrast, in the United States, the available four-factor PCC is exclusively approved for urgent reversal of VKA therapy, not other acquired deficiencies. 13 The major risks of PCCs are thromboembolic complications due to overcorrection of thrombin generation, which in principle is related to the ratio of FII (prothrombin) to antithrombin.…”

Section: Pccsmentioning

confidence: 99%

The use of coagulation factor concentrates for perioperative bleeding management – a global perspective

et al. 2020

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KEY IDEAS The use of purified, pathogen‐reduced coagulation factor concentrates instead of a ratio‐driven transfusion protocol using plasma, platelets, or cryoprecipitate may offer a faster, safer, and more specific approach to significantly increase the concentration of coagulation factors in bleeding patients. Available products, on‐label indications, price, and approach to laboratory monitoring differ considerably worldwide. Although evidence regarding optimal thresholds and dose of coagulation factor concentrates to treat massive perioperative bleeding is still limited, recently multiple high‐quality published trials with promising results have been published globally.

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Use of prothrombin complex concentrate for management of coagulopathy after cardiac surgery: a propensity score matched comparison to plasma

Abstract: Our exploratory study suggests that the use of PCCs as part of a multifaceted coagulation management strategy may have blood-sparing effects. Their incorporation into clinical practice, however, must await determination of their risk-benefit profile via multicentre randomised trials.

Cited by 49 publications

References 26 publications

Hemostatic Management of Extracorporeal Circuits Including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation

Hemostatic Management of Extracorporeal Circuits Including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

The use of coagulation factor concentrates for perioperative bleeding management – a global perspective

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