Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery

Fausto Biancari, Vito G Ruggieri, Andrea Perrotti, Riccardo Gherli, Till Demal, Ilaria Franzese, Magnus Dalén, Giuseppe Santarpino, Antonino S Rubino, Daniele Maselli, Antonio Salsano, Francesco Nicolini, Matteo Saccocci, Giuseppe Gatti, Stefano Rosato, Paola D'Errigo, Eeva-Maija Kinnunen, Marisa De Feo, Tuomas Tauriainen, Francesco OnoratiGiovanni Mariscalco

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Recent studies suggested that prothrombin complex concentrate (PCC) might be more effective than fresh frozen plasma (FFP) to reduce red blood cell (RBC) transfusion requirement after cardiac surgery.

METHODS: This is a comparative analysis of 416 patients who received FFP postoperatively and 119 patients who received PCC with or without FFP after isolated coronary artery bypass grafting (CABG).

RESULTS: Mixed-effects regression analyses adjusted for multiple covariates and participating centres showed that PCC significantly decreased RBC transfusion (67.2% vs. 87.5%, adjusted OR 0.319, 95%CI 0.136-0.752) and platelet transfusion requirements (11.8% vs. 45.2%, adjusted OR 0.238, 95%CI 0.097-0.566) compared with FFP. The PCC cohort received a mean of 2.7±3.7 (median, 2.0, IQR 4) units of RBC and the FFP cohort received a mean of 4.9±6.3 (median, 3.0, IQR 4) units of RBC (adjusted coefficient, -1.926, 95%CI -3.357-0.494). The use of PCC increased the risk of KDIGO (Kidney Disease: Improving Global Outcomes) acute kidney injury (41.4% vs. 28.2%, adjusted OR 2.300, 1.203-4.400), but not of KDIGO acute kidney injury stage 3 (6.0% vs. 8.0%, OR 0.850, 95%CI 0.258-2.796) when compared with the FFP cohort.

CONCLUSIONS: These results suggest that the use of PCC compared with FFP may reduce the need of blood transfusion after CABG.

Original languageEnglish
JournalHeart Lung and Circulation
DOIs
Publication statusE-pub ahead of print - Dec 11 2018

Keywords

  • Coronary surgery
  • Prothrombin complex concentrate

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