Prothrombin Complex Concentrate in Cardiac Surgery: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Hematology
• Anesthesiology

Background:

• Excessive bleeding during cardiac surgery is a significant concern.
• Prothrombin complex concentrate (PCC) is an emerging alternative to fresh frozen plasma (FFP) for managing perioperative coagulopathy.

Purpose of the Study:

• To systematically review and meta-analyze the safety and efficacy of PCC as a first-line treatment for coagulopathy after adult cardiac surgery.
• To compare PCC with FFP in terms of transfusion requirements and adverse outcomes.

Main Methods:

• A systematic literature search of PubMed/MEDLINE, EMBASE, and Cochrane Library was conducted up to March 2018.
• Four studies involving 861 adult cardiac surgery patients were included, comparing PCC with FFP.
• No randomized controlled trials were identified.

Main Results:

• PCC use was associated with a significant reduction in the risk of red blood cell (RBC) transfusion.
• No significant differences were found between PCC and FFP for reexploration for bleeding, 24-hour chest drain output, hospital mortality, stroke, or acute kidney injury.
• A trend towards an increased risk of renal replacement therapy was observed with PCC.

Conclusions:

• PCC appears more effective than FFP in reducing perioperative blood transfusions in adult cardiac surgery patients with significant bleeding.
• No increased risks of thromboembolic events or other adverse reactions were identified.
• Further randomized controlled trials are necessary to definitively establish the safety and efficacy of PCC in this patient population.