(136) Four-Factor Prothrombin Complex Concentrate in Anticoagulation-Naive Cardiothoracic Surgery Patients

Introduction: Postoperative coagulopathy in cardiothoracic (CT) surgery is a multifactorial phenomenon commonly mitigated with four factor prothrombin complex concentrate (4F-PCC). Limited evidence is available to guide 4F-PCC dosing in anticoagulation naïve CT surgery patients. The purpose of this study is to observe the efficacy and safety of low (less than 25 units/kg), medium (25-50 units/kg) and high dose (greater than 50 units/kg) 4F-PCC as an additive hemostatic agent in patients undergoing CT surgery without pre-operative anticoagulation use.

Methods: A retrospective analysis examined patients without pre-operative anticoagulation use who received 4F-PCC during CT surgery between August 2022 and February 2024. Patients were identified via electronic chart review based on type of CT surgery, coronary artery bypass graft and/or valve procedures, followed by dosing range of 4F-PCC administered. The primary efficacy outcome was defined as reduction in chest tube output (CTO) at 12 and 24 hours post procedure and cumulative blood product for 48 hours post 4F-PCC. Secondary outcomes assessed incidence of hemorrhage at 24 hours, and stroke or venous thromboembolism (VTE) at 48 hours. Outcomes were assessed using chi square and Kruskal-Wallis analyses.

Results: The study population consisted of 81 CT surgery patients. The median dose of 4F-PCC was 22.6 units/kg for the low dose group, 27.8 units/kg for the medium dose group, and 53.5 units/kg for the high dose group (p=0.001). The median 12-hour CTO was 755 ml, 640 ml, and 750 ml for low, medium, and high dose 4F-PCC, respectively (p= 0.902). The median 24-hour CTO similarly showed no difference between the three dosing groups (p=0.612). The median cumulative blood product use at 48 hours was 31.9 mL/kg, 32.4 mL/kg, 44.4 mL/kg for low, medium, and high dose 4F-PCC (p=0.467). Incidence of hemorrhage occurred in 4% in low dose 4F-PCC, 10% in medium dose 4F-PCC, and 9.5% in high dose 4F-PCC (p=0.492). No VTE events were observed. One incidence of stroke occurred in the medium and high dose 4F-PCC group.

Conclusions: No association between low, medium, and high dose 4F-PCC on the primary outcome was observed. Doses of 4F-PCC greater than 25 unit/kg may not provide additional hemostatic benefit in CT surgical patients with no pre-operative anticoagulation use.