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

Elena Ashikhmina1, Sameh Said2, Mark M Smith1

  • 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.

The Annals of Thoracic Surgery
|June 27, 2017
PubMed

Insights

Prothrombin complex concentrates (PCCs) show promise for treating bleeding in pediatric cardiac surgery, but more research is needed to establish safe and effective use in children. Current evidence is anecdotal, highlighting the need for studies on dosing and monitoring.

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.
Abstract

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