146: FIXED-DOSE PROTHROMBIN COMPLEX CONCENTRATE FOR POST-CARDIAC SURGERY COAGULOPATHY AND BLEEDING

Abstract

Introduction: Four-factor prothrombin complex concentrate (PCC) use has increased steadily for bleeding and coagulopathy correction post-cardiac surgery. Weight-based dosing has ranged from 15 to 25 units/kg most often for this indication. The aim of this study was to describe post-operative chest tube output and transfusion requirements following a fixed-dose of 1500 units of PCC. Methods: Adult patients receiving PCC post-cardiac surgery from August 2018 to June 2021 were retrospectively evaluated. The primary end point was average hourly chest tube output for 6 hours following PCC administration. Secondary end points included incidence of thromboembolic events, amount of blood products received, and need for additional PCC doses. Results: A total of 124 patients received fixed-dose PCC post-cardiac surgery during the study timeframe. The median equivalent weight-based dose was 16 units/kg. Median cardiopulmonary bypass time was 127 min (IQR 90-159). The most common procedures performed were coronary artery bypass grafting (CABG) and valve repair or replacement (19.4%), aortic replacement and CABG or valve repair or replacement (18.5%), and single valve repair or replacement (18.5%). Average hourly chest tube output for 6 hours post-PCC was 41 mL (IQR 22-75). Forty-seven patients also received fresh frozen plasma. Ten patients received a repeat dose, with the dose ranging from 500 to 1500 units. Five thromboembolic complications were reported within 30 days of PCC administration. Conclusions: Our results suggest that a fixed-dose PCC strategy is effective for bleeding post-cardiac surgery and could result in cost savings compared to traditional weight-based PCC dosing for this indication. Further investigation is warranted to identify optimal dosing strategies for PCC in cardiac surgery related bleeding.