Factor Concentrate-Based Approaches to Blood Conservation in Cardiac Surgery: European Perspectives in 2020

Abstract

Recent European guidelines and expert consensus statements recommend the use of coagulation factor concentrates to improve hemostasis in bleeding patients after cardiac surgery and for patient blood management. This review summarizes the current evidence relating to coagulation management with the help of coagulation factor concentrates as supported by many European experts and institutes. Maintaining a postoperative fibrinogen level > 1.5–2 g/l by administering fibrinogen concentrate in hypofibrinogenemic bleeding patients has been suggested. Likewise, the use of low-dose four-factor prothrombin complex concentrates seems to be relatively safe in bleeding patients. In contrast, the use of recombinant factor VIIa and factor XIII concentrates has been discouraged due to questionable benefit and potentially impaired outcome. The use of coagulation factor concentrates is preferred over the allogeneic blood products in anticipation of a better outcome in many European cardiac surgical centers. However, it remains unclear whether the use of coagulation factor concentrates such as fibrinogen concentrates or four-factor prothrombin complex concentrates is actually associated with better patient outcome.