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Prothrombin Complex Concentrate versus Fresh Frozen Plasma in Adult Patients Undergoing Cardiac Surgery: A Systematic
Patricia Viana1, Jessica Hoffmann Relvas2, Marina Persson3
1Department of Medicine, Universidade do Extremo Sul Catarinense, Criciuma, Brazil.
Insights
Prothrombin complex concentrate (PCC) is effective for managing bleeding after cardiac surgery, reducing chest tube drainage and red blood cell transfusions compared to fresh frozen plasma (FFP). This analysis suggests PCC is a safe and effective alternative.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Cardiac surgery patients experiencing bleeding often receive prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP).
- The comparative effectiveness and safety of PCC versus FFP for managing bleeding in this population are not well-established.
Purpose of the Study:
- To conduct a meta-analysis comparing the efficacy and safety of PCC and FFP in patients undergoing cardiac surgery with bleeding.
- To evaluate outcomes such as blood loss and transfusion requirements.
Main Methods:
- A systematic literature search was performed across MEDLINE, Embase, and Cochrane databases.
- Eight studies involving 1,500 patients were included in the meta-analysis.
- Statistical analysis used pooled risk ratios and mean differences, with data analyzed using Review Manager (RevMan) 5.4.
Main Results:
- Patients receiving PCC showed significantly less chest tube drainage at 24 hours (MD, -148.50 mL).
- The PCC group required fewer red blood cell (RBC) units (MD, -1.02 units) and less frequent RBC transfusions within 24 hours (RR, 0.85).
- No significant differences were observed in secondary outcomes, though a subgroup analysis of RCTs did not fully support the main findings.
Conclusions:
- Prothrombin complex concentrate (PCC) demonstrates efficacy in reducing blood loss and transfusion needs in cardiac surgery patients with bleeding.
- PCC appears to be a safe alternative to fresh frozen plasma (FFP), without an increase in adverse events.
- Further research, particularly high-quality randomized controlled trials, is warranted to confirm these findings.
Background:
Prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) are commonly used to manage bleeding in patients during cardiac surgery. However, the relative efficacy and safety of these 2 strategies remain uncertain.
Methods:
MEDLINE, Embase, and Cochrane were searched for studies comparing PCC and FFP in patients who underwent cardiac surgery complicated by bleeding. Review Manager (RevMan) ver. 5.4 (Nordic Cochrane Centre, The Cochrane Collaboration) was used for statistical analysis. Binary and continuous outcomes were compared using pooled risk ratios and mean differences, respectively. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews under protocol number CRD42022379144.
Results:
We included 8 studies with 1,500 patients, of whom 613 (40.9%) received PCC. The mean follow-up period ranged from 28 to 90 days. The PCC group had significantly lower chest tube drainage at 24 hours (mean difference [MD], -148.50 mL; 95% CI, -253.02 to -43.99 mL; p=0.005; I2=42%). Fewer units of red blood cells (RBCs) were transfused within the first 24 hours (MD, -1.02 units; 95% CI, -1.81 to -0.24 units; p=0.01; I2=56%), and fewer patients required RBC transfusion within the first 24 hours (risk ratio, 0.85; 95% CI, 0.78-0.93; p<0.007; I2=45%) in the PCC group. There were no statistically significant differences in secondary outcomes. Nonetheless, a subgroup analysis of randomized controlled trials failed to corroborate the results obtained from the main analysis.
Conclusion:
Our findings suggest that PCC can be effective, without increased adverse events, when compared with FFP in patients undergoing cardiac surgery complicated by bleeding.
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