Immediate Higher-Dose Prothrombin Complex Concentrate Without Fresh Frozen Plasma or Fibrinogen Concentrate for Significant Coagulopathic Cardiac Surgical Field Bleeding

Prashant Pruthi; Christine Culliver; Hasan Emel; Sophie Georghie; Matthew J Benson; George Matalanis; Fumitaka Yanase; Rinaldo Bellomo

doi:10.1016/j.hlc.2022.05.048

Immediate Higher-Dose Prothrombin Complex Concentrate Without Fresh Frozen Plasma or Fibrinogen Concentrate for Significant Coagulopathic Cardiac Surgical Field Bleeding

Heart Lung Circ. 2022 Sep;31(9):1300-1306. doi: 10.1016/j.hlc.2022.05.048. Epub 2022 Jul 15.

Authors

Prashant Pruthi¹, Christine Culliver², Hasan Emel², Sophie Georghie³, Matthew J Benson³, George Matalanis⁴, Fumitaka Yanase⁵, Rinaldo Bellomo⁶

Affiliations

¹ Intensive Care Unit, Warringal Private Hospital, Melbourne, Vic, Australia.
² Dorevitch Blood Bank at Warringal Private Hospital, Melbourne, Vic, Australia.
³ Department of Anaesthesia, Warringal Private Hospital, Melbourne, Vic, Australia.
⁴ Department of Cardiac Surgery, Warringal Private Hospital, Melbourne, Vic, Australia.
⁵ Department of Intensive Care, Austin Hospital, Melbourne, Vic, Australia.
⁶ Intensive Care Unit, Warringal Private Hospital, Melbourne, Vic, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Vic, Australia; Department of Critical Care, University of Melbourne, Melbourne, Vic, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic, Australia; Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Vic, Australia. Electronic address: Rinaldo.bellomo@austin.org.au.

PMID: 35843859
DOI: 10.1016/j.hlc.2022.05.048

Abstract

Background: Treatment of significant coagulopathic cardiac surgical field bleeding with immediate higher-dose prothrombin complex concentrate (PCC) without fresh frozen plasma (FFP) or fibrinogen concentrate is unexplored.

Aims: To study characteristics, chest drainage, and clinical outcomes of patients with significant coagulopathic surgical field bleeding treated with immediate higher-dose (defined at >15 IU/kg based on factor IX) PCC without FFP or fibrinogen concentrate.

Methods: We screened sequential cardiac surgery patients. We reviewed electronic blood bank data, Australian Society of Cardiothoracic Surgery database information and anaesthetic, intensive care unit (ICU), ward and radiological charts and electronic data. We identified patients deemed by the operating surgeon to require treatment for significant coagulopathic surgical field bleeding who underwent immediate higher-dose PCC without FFP or fibrinogen concentrate.

Results: Among 168 patients, we identified 30 who underwent immediate higher-dose PCC without FFP or fibrinogen concentrate. Median age was 68 years, 23 were male, 17 underwent coronary artery bypass surgery and three underwent complex surgery (David procedure, redo mitral valve surgery, and redo thoraco-abdominal aneurysm repair). Median dose of PCC was 2,500 IU. In addition, 27% underwent platelets and one underwent cryoprecipitate. Chest drainage at 24 hours was 505 ml. Survival to hospital discharge was 100%. There were no cases of pulmonary embolism, stroke, or other thrombotic events. Stage 1 AKI occurred in one patient.

Conclusion: In a pilot cohort of patients with significant coagulopathic surgical field bleeding, immediate higher-dose PCC without FFP or fibrinogen concentrate was feasible and had an acceptable efficacy and safety profile, which justifies future controlled studies.

Keywords: Chest tube drainage; Coagulopathic cardiac surgical field bleeding; Prothrombin complex concentrate; Thrombo-embolic complications.

Publication types

Review

MeSH terms

Aged
Australia
Blood Coagulation Factors
Blood Loss, Surgical
Cardiac Surgical Procedures*
Factor IX
Female
Fibrinogen*
Humans
Male
Plasma

Substances

Blood Coagulation Factors
prothrombin complex concentrates
Factor IX
Fibrinogen