Related Experiment Video
Updated: Jun 23, 2025
Helical Organization of Blood Coagulation Factor VIII on Lipid Nanotubes
Published on: June 3, 2014
Factor Eight Inhibitor Bypassing Activity as First-line Therapy for Coagulopathy in Cardiac Surgery
Hyungjoo Kim1, Frank Manetta1, Alan Hartman1
1Division of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell, New Hyde Park, NY.
Insights
Factor eight inhibitor bypassing activity (FEIBA) may be more effective than fresh frozen plasma (FFP) for treating postcardiac surgery coagulopathy. FEIBA use was associated with fewer blood product transfusions and lower readmission rates.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Postoperative coagulopathy is a common complication after cardiac surgery.
- Fresh frozen plasma (FFP) is a standard treatment, but its efficacy can be limited.
Purpose of the Study:
- To compare the effectiveness of FEIBA and FFP in managing coagulopathy following cardiac surgery.
- To evaluate the impact on blood product transfusion requirements and patient outcomes.
Main Methods:
- Retrospective, propensity-matched study at a single tertiary hospital.
- Included patients undergoing noncoronary cardiac surgery with cardiopulmonary bypass (2015-2023).
- Compared outcomes between patients receiving intraoperative FFP or FEIBA.
Main Results:
- FEIBA group required fewer packed red blood cells, platelets, and cryoprecipitate transfusions.
- FEIBA was associated with shorter intubation times and reduced ICU length of stay.
- Lower 30-day readmission rates were observed in the FEIBA group, with no difference in thrombotic complications.
Conclusions:
- FEIBA may be a more effective first-line treatment for postcardiopulmonary bypass coagulopathy than FFP.
- FEIBA demonstrated benefits in reducing blood product use and readmissions.
- Further research is warranted to support routine use of FEIBA in this patient population.
Objectives:
To compare the outcomes of factor eight inhibitor bypassing activity (FEIBA) versus fresh frozen plasma (FFP) as the primary treatment for postoperative coagulopathy in patients undergoing cardiac surgery.
Design:
A retrospective, propensity-matched study.
Setting:
A single, tertiary hospital.
Participants:
Patients who underwent noncoronary cardiac surgery with cardiopulmonary bypass between 2015 and 2023.
Interventions:
None.
Measurements And Main Results:
We stratified patients into 2 groups based on whether they received intraoperative FFP or FEIBA; cases using both were excluded. We analyzed 434 cases, with 197 receiving FFP and 237 receiving FEIBA. After propensity matching, there was no significant difference in the proportion of the patients who required packed red blood cell transfusions (p = 0.08). However, of those who required packed red blood cell transfusions, patients in the FEIBA group required significantly fewer units of packed red blood cells (p < 0.001). Significantly fewer patients in the FEIBA group required platelet (p < 0.001) and cryoprecipitate (p < 0.001) transfusions. The FEIBA group showed decreased prolonged postoperative intubation (p = 0.05), decreased intensive care unit length of stay (p = 0.04), and lower 30-day readmission rates (p = 0.03). There were no differences in the rates of thrombotic complications between the 2 cohorts.
Conclusions:
In the initial treatment of postcardiopulmonary bypass coagulopathy, FEIBA may be more effective than FFP in decreasing blood product transfusions and readmission rates. Further studies are needed to explore the potential routine use of FEIBA as first-line agent in this patient population.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
01:09Coagulation
During the coagulation phase, clotting factors, or procoagulants, play a vital role in initiating and progressing the coagulation cascade. This cascade is a series of reactions...
01:16Clot Retraction and Fibrinolysis