University of Oulu

Roman M, Biancari F, Ahmed AB, Agarwal S, Hadjinikolaou L, Al-Sarraf A, Tsang G, Oo AY, Field M, Santini F, Mariscalco G, Prothrombin complex concentrate in cardiac surgery: A systematic review and meta-analysis, The Annals of Thoracic Surgery (2018), doi: https://doi.org/10.1016/j.athoracsur.2018.10.013.

Prothrombin complex concentrate in cardiac surgery : a systematic review and meta-analysis

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Author: Roman, Marius1; Biancari, Fausto2,3; Ahmed, Aamer B.4;
Organizations: 1Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital
2Heart Center, Turku University Hospital and University of Turku
3Department of Surgery, University of Oulu
4Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust
5Department of Anaesthesia, Liverpool Heart and Chest Hospital
6Cardiac Surgery Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust
7Cardiac Surgery Unit, University Hospital Southampton NHS Foundation Trust
8Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital
9Department of Cardiac Surgery, Liverpool Heart and Chest Hospital
10Department of Integrated Surgical and Diagnostic Sciences (DISC), Division of Cardiac Surgery, University of Genoa
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe201901152151
Language: English
Published: Elsevier, 2018
Publish Date: 2019-11-17
Description:

Abstract

Background: Prothrombin complex concentrate (PCC) has recently emerged as effective alternative to fresh frozen plasma (FFP) in treating excessive perioperative bleeding. We performed a systematic review and meta-analysis to evaluate the safety and efficacy of PCC administration as first-line treatment for coagulopathy following adult cardiac surgery.

Methods: We searched PubMed/MEDLINE, EMBASE, and the Cochrane Library from inception to the end of March 2018 to identify eligible articles. Adult patients undergoing cardiac surgery and receiving perioperative PCC were compared to those receiving FFP.

Results: A total of 861 adult patients from 4 studies were retrieved. No randomized studies were identified. Pooled odds ratio (OR) showed that PCC cohort was associated with a significant reduction in the risk of RBC transfusion (OR: 2.22; 95% confidence interval [CI] 1.45–3.40) and units of RBC received (OR: 1.34; 95%CI: 0.78–1.90). No differences were observed between the groups for re-exploration for bleeding (OR: 1.09; 95%CI: 0.66–1.82), chest drain output at 24 hours (OR: 66.36; 95%CI: -82.40–216.11), hospital mortality (OR: 0.94; 95%CI: 0.59–1.49), stroke (OR: 0.80; 95%CI: 0.41–1.56), and occurrence of acute kidney injury (OR: 0.80; 95%CI: 0.58–1.12). A trend toward increased risk of renal replacement therapy was observed in the PCC group (OR: 0.41; 95%CI: 0.16–1.02).

Conclusions: In patients with significant bleeding following cardiac surgery, PCC administration seems to be more effective than FFP in reducing perioperative blood transfusions. No additional risks of thromboembolic events or other adverse reactions were observed. Randomized controlled trials are needed to definitively establish the safety of PCC in cardiac surgery.

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Series: The annals of thoracic surgery
ISSN: 0003-4975
ISSN-E: 1552-6259
ISSN-L: 0003-4975
Issue: In press
DOI: 10.1016/j.athoracsur.2018.10.013
OADOI: https://oadoi.org/10.1016/j.athoracsur.2018.10.013
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Copyright information: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/