Abstract
BackgroundBleeding after cardiac surgery requiring surgical reexploration and blood component transfusion is associated with increased morbidity and mortality. Although prothrombin complex concentrate (PCC) has been used satisfactorily in bleeding disorders, studies on its efficacy and safety after cardiopulmonary bypass are limited.MethodsBetween January 2005 and December 2013, 3454 consecutive cardiac surgery patients were included in an observational study aimed at investigating the efficacy and safety of PCC as first-line coagulopathy treatment as a replacement for fresh frozen plasma (FFP). Starting in January 2012, PCC was introduced as solely first-line treatment for bleeding following cardiac surgery.ResultsAfter one-to-one propensity score–matched analysis, 225 pairs of patients receiving PCC (median dose 1500 IU) and FFP (median dose 2 U) were included. The use of PCC was associated with significantly decreased 24-h post-operative blood loss (836 ± 1226 vs. 935 ± 583 ml, p < 0.0001). Propensity score–adjusted multivariate analysis showed that PCC was associated with significantly lower risk of red blood cell (RBC) transfusions (odds ratio [OR] 0.50; 95 % confidence interval [CI] 0.31–0.80), decreased amount of RBC units (β unstandardised coefficient −1.42, 95 % CI −2.06 to −0.77) and decreased risk of transfusion of more than 2 RBC units (OR 0.53, 95 % CI 0.38–0.73). Patients receiving PCC had an increased risk of post-operative acute kidney injury (AKI) (OR 1.44, 95 % CI 1.02–2.05) and renal replacement therapy (OR 3.35, 95 % CI 1.13–9.90). Hospital mortality was unaffected by PCC (OR 1.51, 95 % CI 0.84–2.72).ConclusionsIn the cardiac surgery setting, the use of PCC compared with FFP was associated with decreased post-operative blood loss and RBC transfusion requirements. However, PCC administration may be associated with a higher risk of post-operative AKI.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1172-6) contains supplementary material, which is available to authorized users.
Highlights
Bleeding after cardiac surgery requiring surgical reexploration and blood component transfusion is associated with increased morbidity and mortality
Major imbalances were documented in the prevalence of pre-operative use of warfarin and aspirin, New York Heart Association classes III and IV, diabetes, cerebrovascular disease, myocardial infarction, isolated coronary artery bypass graft (CABG), and emergency procedures
We estimated a propensity score of this subset of patients, and its area under the receiver operating characteristic (ROC) curve was Discussion The present study demonstrates that the early use of prothrombin complex concentrate (PCC) instead of fresh frozen plasma (FFP) was associated with a significant reduction in blood transfusion requirements
Summary
Bleeding after cardiac surgery requiring surgical reexploration and blood component transfusion is associated with increased morbidity and mortality [1,2,3,4]. Cappabianca et al Critical Care (2016) 20:5 prions [16] Despite these potential advantages, concerns about an increased risk of thrombogenic events have been raised, and only a minority of studies have investigated the use of PCCs in cardiac surgery. The purpose of the present study, was to investigate the safety and efficacy of PCC as first-line treatment in coagulopathy in a consecutive series of patients undergoing cardiac surgery
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