Prothrombin Complex Concentrates in Pediatric Cardiac Surgery: The Current State and the Future.

Area of Science:

• Pediatric Cardiac Surgery
• Hemostasis and Coagulation
• Pharmacology

Background:

• Postoperative bleeding is a persistent concern in pediatric cardiac surgery due to immature hemostasis, hemodilution, and hypothermia.
• Prothrombin complex concentrates (PCCs), used off-label in adults for post-bypass hemorrhage, offer potential benefits for pediatric patients.
• Optimal use, including dosing and monitoring, of PCCs in children remains undefined.

Purpose of the Study:

• To review the challenges of bypass-related coagulopathy in pediatric cardiac surgery.
• To outline the pharmacology and existing experience with PCCs.
• To explore the potential application of PCCs in pediatric cardiac surgery.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE, Scopus, and Ovid databases.
• The search term used was "prothrombin complex concentrate AND pediatric."
• Twenty-three relevant articles were selected for review.

Main Results:

• While PCCs demonstrate attractive qualities for pediatric use (small volume, low immunogenicity, rapid action), current evidence is anecdotal.
• Key concerns include undefined dosing regimens and the lack of real-time monitoring capabilities.
• Potential thrombotic complications pose a significant risk, especially in pediatric patients reliant on artificial shunts.

Conclusions:

• Extensive, high-quality research is essential to address the knowledge gaps concerning PCC use in pediatric cardiac surgery.
• Further investigation is required to establish safe and effective protocols for PCC administration in this population.