Utility of prothrombin complex concentrate as first‐line treatment modality of coagulopathy in patients undergoing liver transplantation: A propensity score‐matched study

Abstract

Background Transfusion management during liver transplantation (LT) is aimed at reducing blood loss and allogeneic transfusion requirements. Although prothrombin complex concentrate (PCC) has been used satisfactorily in various bleeding disorders, studies on its safety, and efficacy during LT are limited. Methods A retrospective chart review of adult patients who underwent living donor LT at a single institute between October 2016 and January 2018 was carried out. The safety and efficacy of PCC in reducing transfusion requirements intraoperatively in patients who received PCC were compared with patients who did not receive PCC. A propensity score‐matching technique was used, at a 1:1 ratio, to remove selection bias. Results After completing the 1:1 propensity score‐matched analysis, 60 pairs of patients were identified. The use of PCC was associated with significantly decreased red blood cell transfusion requirements (6.2 ± 4.1 vs 8.23 ± 5.18, P < 0.001) and fresh frozen plasma transfusion requirements (2.6 ± 2 vs 6.18 ± 4.1, P < 0.001). The number of patients developing postoperative hemorrhagic complications was higher in the non‐PCC group. Conclusions During LT, the use of PCC led to decreased transfusion requirements. No thromboembolic complications related to PCC were noted in this series.

In Vitro Evaluation of Pro- and Anticoagulant Drugs in Children with End-Stage Liver Disease Undergoing Liver Transplantation

“…Blood transfusion requirement remains substantial in pediatric LT. 1,10 Along with red blood cell transfusion, fresh-frozen plasma (FFP) and 4-factor prothrombin complex concentrates (PCCs) are frequently administered as prohemostatic agents in clinical practice. [11][12][13] However, these strategies to prevent or treat bleeding complications are largely based on empiric considerations. In adults with cirrhosis, in vitro addition of FFP to plasma of patients showed a lack of prohemostatic effect, whereas an exaggerated response was observed after addition of the 4-factor PCC.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2018

“…No thromboembolic complications related to PCC were noted. 77 The study suggests that the use of PCC during LT may be safe and lead to decreased transfusion requirements.…”

“…To address the concern of volume overload for traditional blood component coagulation therapy, prothrombin complex concentrate (PCC) has been advocated as an attractive alternative. Srivastava et al 77 performed a 1:1 propensity score–matched analysis on 120 patients undergoing LDLT. The use of PCC was associated with significantly decreased PRBC requirements (6.2 ± 4.1 vs 8.2 ± 5.2 units, P < .001) and fresh frozen plasma requirements (2.6 ± 2.0 vs 6.2 ± 4.1 units, P < .001).…”

Adult liver transplant anesthesiology practice patterns and resource utilization in the United States: Survey results from the society for the advancement of transplant anesthesia

“…Although, the safety of both prothrombin complex concentrates and fibrinogen concentrates has been previously described 17,18 there is insufficient robust prospective data to support the utility of these agents to reduce transfusion of blood products. 19,20…”