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Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation

Daniel H Enter1, Anthony L Zaki1, Megan Marsh2

  • 1Cardiac Surgery, Northwestern University, Chicago, Illinois.

Pharmacotherapy
|August 24, 2017
PubMed

Insights

Four-factor prothrombin complex concentrate (4-F PCC) significantly reduced blood product use in patients undergoing warfarin reversal before heart transplantation. This includes fewer fresh frozen plasma (FFP) transfusions, improving perioperative care.

Area of Science:

  • Cardiology
  • Hematology
  • Transplantation Medicine

Background:

  • Warfarin reversal before cardiac surgery typically involves vitamin K and fresh frozen plasma (FFP).
  • The efficacy of prothrombin complex concentrate (PCC) for warfarin reversal lacks clear consensus.
  • Four-factor (4-F) PCC is increasingly considered for perioperative warfarin management.

Purpose of the Study:

  • To evaluate the efficacy of 4-F PCC in reducing blood product utilization.
  • To compare perioperative blood product use in patients receiving 4-F PCC versus standard care.
  • To assess the impact of 4-F PCC on warfarin reversal before heart transplantation.

Main Methods:

  • Retrospective cohort study comparing 21 patients receiving 4-F PCC with 39 controls.
  • Blood product utilization was analyzed for 24-hour preoperative, intraoperative, and 48-hour postoperative periods.
  • Data collected from January 2011 to July 2015 at a single center.

Main Results:

  • Patients receiving 4-F PCC required significantly fewer blood products preoperatively (10% vs 56%, p<0.001).
  • The 4-F PCC group showed reduced intraoperative use of packed red blood cells (median 3 vs 7 units, p<0.001) and FFP (median 4 vs 9 units, p<0.001).
  • Postoperatively, fewer patients in the 4-F PCC group received blood products (24% vs 51%, p=0.04).

Conclusions:

  • 4-F PCC administration is associated with decreased perioperative blood product utilization.
  • Significant reduction in fresh frozen plasma (FFP) requirements was observed with 4-F PCC.
  • 4-F PCC offers a potentially more effective strategy for warfarin reversal in cardiac surgery patients.
Abstract

Keywords:
heart transplantationprothrombin complex concentratewarfarin reversal

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