Using Plasma and Prothrombin Complex Concentrates.

Area of Science:

• Anesthesiology
• Hematology
• Surgical Critical Care

Background:

• Surgical patients with bleeding require effective volume resuscitation and transfusion management.
• Transfusions, while correcting coagulopathy, pose risks like circulatory overload and transfusion-related acute lung injury.
• Factor concentrates, such as prothrombin complex concentrates (PCCs), are utilized in multimodal bleeding therapy.

Purpose of the Study:

• To discuss the perioperative use of prothrombin complex concentrates (PCCs), plasma, and fresh frozen plasma (FFP).
• To highlight the need for comparative studies on the efficacy of PCCs versus FFP and other therapies.
• To address the role of PCCs in managing coagulopathy associated with non-vitamin K oral anticoagulants in surgical settings.

Main Methods:

• Review of current literature and clinical practices regarding perioperative hemostatic management.
• Discussion of the indications and potential risks associated with PCCs, plasma, and FFP.
• Analysis of the current evidence supporting the use of these agents in bleeding surgical patients.

Main Results:

• PCCs are commonly used alongside laboratory testing for coagulopathy assessment.
• Existing studies are insufficient to definitively establish the superiority of PCCs over FFP or other treatments.
• PCCs are specifically indicated for perioperative coagulopathy linked to non-vitamin K oral anticoagulants.

Conclusions:

• Perioperative management of bleeding surgical patients involves PCCs, plasma, and FFP.
• Further research is essential to guide optimal therapeutic choices between PCCs and FFP.
• The role of PCCs in managing specific coagulopathies, like those from DOACs, is established.