Factor Eight Inhibitor Bypassing Activity as First-line Therapy for Coagulopathy in Cardiac Surgery

Abstract

ObjectiveTo compare the outcomes of Factor Eight Inhibitor Bypassing Activity (FEIBA) versus Fresh Frozen Plasma (FFP) as the primary treatment for postoperative coagulopathy in cardiac surgery patients. DesignA retrospective, propensity-matched study. SettingA single, tertiary hospital. ParticipantsPatients who underwent non-coronary open-heart surgery with cardiopulmonary bypass between 2015 and 2023. InterventionsNone. Measurements and Main ResultsWe stratified patients into two groups based on whether they received intraoperative FFP or FEIBA, while cases using both were excluded. We analyzed 434 cases, with 197 receiving FFP and 237 receiving FEIBA. After propensity-matching, there was no significant difference in the proportion of the patients who required pRBC transfusions (p=0.08). However, of those who required pRBC transfusions, patients in the FEIBA group required significantly less units of pRBC (p<0.001). Significantly less patients in the FEIBA group required platelet (p<0.001) and cryoprecipitate (p<0.001) transfusions. The FEIBA group showed reduced prolonged postoperative intubation (p=0.05), reduced ICU length of stay (p=0.04), and lower 30-day readmission rates (p=0.03). There were no differences in rates of thrombotic complications between the two cohorts. ConclusionsIn the initial treatment of post-cardiopulmonary bypass coagulopathy, FEIBA may be more effective than FFP in reducing blood product transfusions and readmission rates. Further studies are needed to explore the potential routine use of FEIBA as first line agent in this patient population.