(1000) Evaluation of Four-Factor Prothrombin Complex Concentrate for Bleeding in Cardiac Surgery

Introduction: Consumptive coagulopathy and post-operative bleeding are well-described complications of cardiac surgery and cardiopulmonary bypass (CPB). Administration of fresh frozen plasma (FFP) is standard of care for coagulopathy reversal after cardiac surgery. Prothrombin complex concentrate (PCC) has been proposed as an alternative or adjunct to FFP for coagulation factor repletion in reduced volumes with lower risk of transfusion-related complications. This study evaluated the effectiveness of four-factor PCC (4F-PCC) with or without FFP vs. FFP alone for bleeding after cardiac surgery.

Methods: A retrospective analysis of adults who underwent cardiac surgery with open sternotomy and received 4F-PCC and/or FFP within 24 hours for post-operative bleeding was performed. The primary outcome was chest tube output in the 24-hour post-operative period. Secondary outcomes included post-operative chest tube output at 6 and 12 hours, blood product transfusions at 24 hours, surgical re-exploration, 4F-PCC redosing, intensive care unit (ICU) and hospital lengths of stay. Safety outcomes included 30-day thrombotic events, 7-day acute kidney injury (AKI) and in-hospital mortality.

Results: Of 210 included patients, 70 were treated with 4F-PCC vs. 140 with FFP alone. Aortic (31.4%) and valvular (28.1%) surgeries were the most common procedures. The 4F-PCC group had significantly longer CPB (109 vs. 86 minutes [P=0.007]) and aortic cross clamp times (77 vs. 59 minutes [P=0.008]). The 4F-PCC group had significantly greater chest tube output at hour 6 (1,294 vs. 772 mL [P < 0.001]), 12 (1,692 vs. 1,165 mL [P=0.001]) and 24 (2,177 vs. 1,641 mL [P=0.006]) after surgery. The 4F-PCC group had significantly higher 24-hour post-operative blood product transfusion requirements, surgical re-exploration and ICU length of stay. The 4F-PCC group had numerically higher rates of thrombotic events, AKI and in-hospital mortality; however, these differences were not statistically significant.

Conclusions: Patients in the 4F-PCC group had more post-operative chest tube output and blood product transfusion requirements. Patients in this group underwent significantly more complex aortic and valvular surgeries with longer CPB and aortic cross-clamp times which may have affected their hemostasis, leading to higher rates of bleeding.