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Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay
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Outcomes Following Three-Factor Inactive Prothrombin Complex Concentrate Versus Recombinant Activated Factor VII

Patrick C Harper1, Mark M Smith1, Nathan J Brinkman2

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

Journal of Cardiothoracic and Vascular Anesthesia
|December 9, 2017
PubMed
Summary
This summary is machine-generated.

Inactive prothrombin complex concentrate (PCC) reduced postoperative bleeding and transfusions compared to recombinant activated factor VII (rFVIIa) in cardiac surgery patients. PCC also decreased the need for dialysis, with no difference in mortality.

Keywords:
BebulinNovoSevencardiac surgeryfactor IX complexprothrombin complex concentraterecombinant activated factor VII

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Area of Science:

  • Anesthesiology
  • Cardiovascular Surgery
  • Hematology

Background:

  • Managing bleeding during cardiac surgery is critical.
  • Recombinant activated factor VII (rFVIIa) and prothrombin complex concentrate (PCC) are used for hemostasis.
  • Comparing their efficacy and safety is important for patient outcomes.

Purpose of the Study:

  • To compare the clinical outcomes of using inactive 3-factor PCC versus rFVIIa in patients undergoing cardiac surgery.
  • To evaluate the impact on postoperative bleeding, transfusion requirements, and renal function.

Main Methods:

  • Retrospective propensity-matched analysis of patients undergoing cardiac surgery with cardiopulmonary bypass.
  • Comparison of outcomes between patients receiving intraoperative rFVIIa or inactive 3-factor PCC for bleeding control.

Main Results:

  • Patients receiving PCC had significantly less chest tube output, lower rates of fresh frozen plasma and platelet transfusions compared to rFVIIa.
  • PCC use was associated with a significantly lower likelihood of requiring postoperative dialysis.
  • No significant differences were observed in stroke, deep venous thrombosis, pulmonary embolism, myocardial infarction, intracardiac thrombus, or 30-day mortality between the groups.

Conclusions:

  • Inactive 3-factor PCC is associated with reduced postoperative bleeding and transfusion needs compared to rFVIIa in cardiac surgery.
  • PCC use may decrease the incidence of renal failure requiring dialysis post-cardiac surgery.
  • rFVIIa use was linked to increased postoperative bleeding, transfusions, and renal failure.