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Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery

Fausto Biancari1, Vito G Ruggieri2, Andrea Perrotti3

  • 1Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland; Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland.

Heart, Lung & Circulation
|February 3, 2019
PubMed

Insights

Prothrombin complex concentrate (PCC) significantly reduced red blood cell (RBC) and platelet transfusions after coronary artery bypass grafting (CABG) compared to fresh frozen plasma (FFP). However, PCC use was associated with a higher risk of acute kidney injury.

Area of Science:

  • Cardiovascular Surgery
  • Transfusion Medicine
  • Nephrology

Background:

  • Recent studies indicate Prothrombin Complex Concentrate (PCC) may be superior to Fresh Frozen Plasma (FFP) in reducing red blood cell (RBC) transfusions post-cardiac surgery.
  • Investigating the comparative efficacy of PCC versus FFP in transfusion management after cardiac procedures is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare the effectiveness of Prothrombin Complex Concentrate (PCC) versus Fresh Frozen Plasma (FFP) in reducing transfusion requirements after isolated coronary artery bypass grafting (CABG).
  • To evaluate the impact of PCC and FFP on the incidence of acute kidney injury (AKI) following CABG surgery.

Main Methods:

  • A comparative analysis involving 416 patients receiving FFP and 119 patients receiving PCC (with or without FFP) postoperatively after isolated CABG.
  • Mixed-effects regression analyses were employed to adjust for covariates and participating centers, assessing transfusion outcomes and AKI incidence.

Main Results:

  • PCC significantly decreased RBC transfusion rates (67.2% vs. 87.5%) and platelet transfusion requirements (11.8% vs. 45.2%) compared to FFP.
  • Patients receiving PCC required fewer RBC units (mean 2.7 vs. 4.9 units).
  • PCC use was linked to an increased risk of KDIGO acute kidney injury (41.4% vs. 28.2%), but not KDIGO stage 3 AKI.

Conclusions:

  • Prothrombin Complex Concentrate (PCC) may effectively reduce the need for RBC and platelet transfusions following CABG surgery when compared to Fresh Frozen Plasma (FFP).
  • While PCC offers transfusion benefits, its association with an increased risk of acute kidney injury warrants careful consideration in clinical practice.
Abstract

Keywords:
BleedingCardiac surgeryFresh frozen plasmaProthrombin complex concentrateTransfusion

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