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Title: Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery
Authors: Cappabianca, G.
Mariscalco, Giovanni
Biancari, F.
Maselli, D.
Papesso, F.
Cottini, M.
Crosta, S.
Banescu, S.
Ahmed, A. B.
Beghi, C.
First Published: 6-Jan-2016
Publisher: BioMed Central
Citation: Critical Care, 2016, 20 (1), 5
Abstract: BACKGROUND: Bleeding 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. METHODS: Between 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. RESULTS: After 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). CONCLUSIONS: In 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.
DOI Link: 10.1186/s13054-015-1172-6
ISSN: 1364-8535
eISSN: 1466-609X
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © Cappabianca et al. 2015. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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