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Three‐factor prothrombin complex concentrates for refractory bleeding after cardiovascular surgery within an algorithmic approach to haemostasis
Author(s) -
Hashmi Nazish K.,
Ghadimi Kamrouz,
Srinivasan Amudan J.,
Li YiJu,
Raiff Robert D.,
Gaca Jeffrey G.,
Root Adam G.,
Barac Yaron D.,
Ortel Thomas L.,
Levy Jerrold H.,
Welsby Ian J.
Publication year - 2019
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.12774
Subject(s) - medicine , perioperative , prothrombin complex concentrate , refractory (planetary science) , surgery , incidence (geometry) , blood product , dosing , anesthesia , blood transfusion , warfarin , atrial fibrillation , physics , astrobiology , optics
Background/Objectives Prothrombin complex concentrates ( PCC ) are increasingly administered off‐label in the United States to treat bleeding in cardiovascular surgical patients and carry the potential risk for acquired thromboembolic side‐effects after surgery. Therefore, we hypothesized that the use of low‐dose 3‐factor (3F) PCC (20‐30 IU /kg), as part of a transfusion algorithm, reduces bleeding without increasing postoperative thrombotic/thromboembolic complications. Materials/Methods After IRB approval, we retrospectively analysed 114 consecutive, complex cardiovascular surgical patients (age > 18 years), between February 2014 and June 2015, that received low‐dose 3F‐ PCC (Profilnine ® ), of which seven patients met established exclusion criteria. PCC was dosed according to an institutional perioperative algorithm. Allogeneic transfusions were recorded before and after PCC administration ( n = 107). The incidence of postoperative thromboembolic events was determined within 30 days of surgery, and Factor II levels were measured in a subset of patients ( n = 20) as a quality control measure to avoid excessive PCC dosing. Results Total allogeneic blood product transfusion reached a mean of 12·4 ± 9·9 units before PCC and 5·0 ± 6·3 units after PCC administration ( P < 0·001). The mean PCC dose was 15·8 ± 7·1 IU /kg. Four patients (3·8%) each experienced an ischaemic stroke on postoperative day 1, 2, 4 and 27. Seven patients (6·5%) had acquired venous thromboembolic disease within 10 days of surgery. Median factor II level after transfusion algorithm adherence and PCC administration was 87%. Conclusions 3F‐ PCC use for refractory bleeding after cardiovascular surgery resulted in reduced transfusion of allogeneic blood and blood products. Adherence to this algorithmic approach was associated with an acceptable incidence of postoperative thrombotic/thromboembolic complications.