Prothrombin complex concentrate mitigates diffuse bleeding after cardiopulmonary bypass in a porcine model

Area of Science:

• Cardiovascular Surgery
• Hematology
• Anesthesiology

Background:

• Cardiopulmonary bypass (CPB) can cause dilutional coagulopathy and bleeding due to extracorporeal circuit priming and volume expansion.
• Prothrombin complex concentrate (PCC), containing clotting factors II, VII, IX, and X, is a potential treatment for coagulopathy and blood loss.

Purpose of the Study:

• To evaluate the efficacy of PCC in correcting dilutional coagulopathy and reducing postoperative bleeding in a large-animal CPB model.
• To assess the impact of PCC on suture hole blood loss and bleeding time after CPB.

Main Methods:

• Pigs underwent hypothermic CPB for 3 hours.
• Animals received either saline or PCC (30 IU kg⁻¹) post-CPB.
• Suture hole blood loss and skin bleeding time were measured to assess diffuse coagulopathic bleeding.

Main Results:

• PCC fully or partially reversed the decline in clotting factors II, VII, IX, and X observed after CPB.
• PCC significantly reduced suture hole blood loss by a median of 54 ml compared to saline (P=0.026).
• PCC normalized skin bleeding time and restored peak thrombin generation post-CPB.

Conclusions:

• PCC effectively corrected dilutional coagulopathy and reduced diffuse bleeding in a large-animal CPB model.
• PCC demonstrates potential as a hemostatic agent in patients undergoing CPB.
• Further research is recommended to investigate PCC's role in CPB-related hemostasis.