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 journalArticle

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

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Erythrocyte Transfusion
Kidney Diseases
Acute Kidney Injury
Coronary Artery Bypass
Erythrocytes
Platelet Transfusion
prothrombin complex concentrates
Blood Transfusion
Thoracic Surgery
Regression Analysis

Keywords

  • Coronary surgery
  • Prothrombin complex concentrate

Cite this

Biancari, F., Ruggieri, V. G., Perrotti, A., Gherli, R., Demal, T., Franzese, I., ... Mariscalco, G. (2018). Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery. Heart Lung and Circulation. https://doi.org/10.1016/j.hlc.2018.10.025

Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery. / Biancari, Fausto; Ruggieri, Vito G; Perrotti, Andrea; Gherli, Riccardo; Demal, Till; Franzese, Ilaria; Dalén, Magnus; Santarpino, Giuseppe; Rubino, Antonino S; Maselli, Daniele; Salsano, Antonio; Nicolini, Francesco; Saccocci, Matteo; Gatti, Giuseppe; Rosato, Stefano; D'Errigo, Paola; Kinnunen, Eeva-Maija; De Feo, Marisa; Tauriainen, Tuomas; Onorati, Francesco; Mariscalco, Giovanni.

In: Heart Lung and Circulation, 11.12.2018.

Research output: Contribution to journalArticle

Biancari, F, Ruggieri, VG, Perrotti, A, Gherli, R, Demal, T, Franzese, I, Dalén, M, Santarpino, G, Rubino, AS, Maselli, D, Salsano, A, Nicolini, F, Saccocci, M, Gatti, G, Rosato, S, D'Errigo, P, Kinnunen, E-M, De Feo, M, Tauriainen, T, Onorati, F & Mariscalco, G 2018, 'Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery', Heart Lung and Circulation. https://doi.org/10.1016/j.hlc.2018.10.025
Biancari, Fausto ; Ruggieri, Vito G ; Perrotti, Andrea ; Gherli, Riccardo ; Demal, Till ; Franzese, Ilaria ; Dalén, Magnus ; Santarpino, Giuseppe ; Rubino, Antonino S ; Maselli, Daniele ; Salsano, Antonio ; Nicolini, Francesco ; Saccocci, Matteo ; Gatti, Giuseppe ; Rosato, Stefano ; D'Errigo, Paola ; Kinnunen, Eeva-Maija ; De Feo, Marisa ; Tauriainen, Tuomas ; Onorati, Francesco ; Mariscalco, Giovanni. / Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery. In: Heart Lung and Circulation. 2018.
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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.",
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author = "Fausto Biancari and Ruggieri, {Vito G} and Andrea Perrotti and Riccardo Gherli and Till Demal and Ilaria Franzese and Magnus Dal{\'e}n and Giuseppe Santarpino and Rubino, {Antonino S} and Daniele Maselli and Antonio Salsano and Francesco Nicolini and Matteo Saccocci and Giuseppe Gatti and Stefano Rosato and Paola D'Errigo and Eeva-Maija Kinnunen and {De Feo}, Marisa and Tuomas Tauriainen and Francesco Onorati and Giovanni Mariscalco",
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TY - JOUR

T1 - Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery

AU - Biancari, Fausto

AU - Ruggieri, Vito G

AU - Perrotti, Andrea

AU - Gherli, Riccardo

AU - Demal, Till

AU - Franzese, Ilaria

AU - Dalén, Magnus

AU - Santarpino, Giuseppe

AU - Rubino, Antonino S

AU - Maselli, Daniele

AU - Salsano, Antonio

AU - Nicolini, Francesco

AU - Saccocci, Matteo

AU - Gatti, Giuseppe

AU - Rosato, Stefano

AU - D'Errigo, Paola

AU - Kinnunen, Eeva-Maija

AU - De Feo, Marisa

AU - Tauriainen, Tuomas

AU - Onorati, Francesco

AU - Mariscalco, Giovanni

N1 - Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

PY - 2018/12/11

Y1 - 2018/12/11

N2 - 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.

AB - 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.

KW - Coronary surgery

KW - Prothrombin complex concentrate

U2 - 10.1016/j.hlc.2018.10.025

DO - 10.1016/j.hlc.2018.10.025

M3 - Article

C2 - 30709591

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

SN - 1443-9506

ER -