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Intraoperative Administration of 4-Factor Prothrombin Complex Concentrate Reduces Blood Requirements in Cardiac

Gina H Sun1, Visal Patel2, Ingrid Moreno-Duarte2

  • 1Tufts University School of Medicine, Boston, MA.

Journal of Cardiothoracic and Vascular Anesthesia
|December 5, 2017
PubMed

Insights

Intraoperative four-factor prothrombin complex concentrate (4F-PCC) use in heart transplant patients with left ventricular assist devices (LVADs) reduced blood product needs and shortened chest closure time. This approach did not increase complications, offering a safer alternative for warfarin reversal.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Anesthesiology

Background:

  • Patients with left ventricular assist devices (LVADs) often require anticoagulation with warfarin.
  • Orthotopic heart transplantation (OHT) in these patients presents challenges in managing anticoagulation and potential bleeding.
  • Intraoperative warfarin reversal strategies are crucial for optimizing surgical outcomes.

Purpose of the Study:

  • To assess the efficacy of intraoperative four-factor prothrombin complex concentrate (4F-PCC) in patients undergoing OHT with pre-existing LVADs on warfarin.
  • To evaluate the impact of 4F-PCC on blood product utilization, surgical time, and patient outcomes.
  • To determine the safety profile of 4F-PCC in this specific patient population.

Main Methods:

  • Retrospective analysis of 74 patients who underwent OHT at a single university hospital.
  • Comparison between 32 patients who received 4F-PCC for warfarin reversal and 42 patients who did not.
  • 4F-PCC was administered with one-third pre-cardiopulmonary bypass (CPB) and two-thirds post-CPB.

Main Results:

  • The 4F-PCC group showed significantly reduced use of plasma, cryoprecipitate, and packed red blood cells.
  • Time to chest closure was significantly shorter in the 4F-PCC group compared to the control group.
  • No significant differences were observed in platelet transfusion requirements, ICU/hospital length of stay, acute kidney injury, mortality, or thromboembolic complications.

Conclusions:

  • Intraoperative 4F-PCC effectively reverses warfarin anticoagulation in LVAD patients undergoing OHT.
  • This strategy is associated with decreased blood product utilization and reduced surgical time.
  • 4F-PCC administration is safe, with no increase in adverse events like renal injury, thrombosis, or mortality.
Abstract

Keywords:
4F-PCCCoagulopathyComplex ConcentrateFour Factor ProthrombinOrthotopic Heart TransplantationTransfusion

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