Related Experiment Video
Updated: Jan 10, 2026
Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo
Published on: August 4, 2018
Prothrombin Complex Concentrate Versus Fresh Frozen Plasma in Patients Undergoing Cardiac Surgery: A Systematic
Muhammad Hassan Waseem1, Zain Ul Abideen2, Ameer Haider Cheema3
1Allama Iqbal Medical College, Lahore, Pakistan.
Insights
Prothrombin Complex Concentrates (PCC) significantly reduce bleeding after cardiac surgery compared to Fresh Frozen Plasma (FFP). PCC decreases chest tube drainage and red blood cell transfusions without increasing risks of stroke, clots, or mortality.
Area of Science:
- Cardiology
- Hematology
- Transfusion Medicine
Background:
- Excessive bleeding and coagulopathy are common complications following cardiac surgery.
- Fresh Frozen Plasma (FFP) is the standard treatment, but its efficacy and safety compared to alternatives are debated.
Purpose of the Study:
- To compare the effectiveness and safety of Prothrombin Complex Concentrates (PCC) versus FFP in managing post-cardiac surgery bleeding.
- To evaluate key clinical outcomes including blood loss, transfusion requirements, and adverse events.
Main Methods:
- A systematic meta-analysis of 9 studies (4 RCTs, 5 observational studies) involving 1920 patients.
- Searched PubMed, Cochrane Central, and ScienceDirect databases up to April 2025.
- Pooled data using random-effects models, assessed heterogeneity, and evaluated publication bias.
Main Results:
- PCC significantly reduced chest tube drainage within 24 hours compared to FFP (MD -170.05 mL).
- PCC also led to significant reductions in red blood cell (RBC) units transfused (MD -1.06 units) and patients requiring RBC transfusion (RR 0.84).
- No significant differences were observed in stroke, thromboembolic events, or 30-day all-cause mortality between PCC and FFP groups.
Conclusions:
- PCC is effective in reducing blood loss and transfusion needs in the early post-cardiac surgery period.
- PCC demonstrates a comparable safety profile to FFP regarding major adverse events like stroke, thromboembolism, and mortality.
Background:
Excessive bleeding and coagulopathy frequently occur after cardiac surgery, and Fresh Frozen Plasma (FFP) remains the standard treatment. Prothrombin Complex Concentrates (PCC) present a potential alternative; however, their effectiveness and safety compared to FFP remain uncertain.
Methods:
Electronic databases, including PubMed, Cochrane Central, and ScienceDirect, were searched from inception till April 2025. The risk ratios (RR) and mean differences (MD) were pooled using the random-effects model in Review Manager software for the dichotomous and continuous outcomes, respectively. Leave-one-out sensitivity analysis and GRADE assessment were performed to evaluate the cause of heterogeneity and assess the certainty of evidence, respectively. Publication bias was evaluated visually through funnel plots and statistically through Egger's regression test.
Results:
This meta-analysis included 9 studies-comprising 4 randomized controlled trials and 5 observational studies-covering a total of 1920 patients. PCC is associated with a significant reduction in chest tube drainage output within 24 hours compared to FFP (MD -170.05, 95% CI, -253.54 to -86.56; P < .0001; I 2 = 38%). Similarly, the number of RBC units transfused (MD -1.06, 95% CI, -1.57 to -0.55, P < .0001; I 2 = 45%) and number of patients requiring RBC transfusion (RR 0.84, 95% CI, 0.77-0.92; P < .0001; I 2 = 47%) within first 24 hours are both reduced significantly in the PCC arm. Other outcomes including stroke (RR 1.03, 95% CI, 0.63-1.69; P = .90; I 2 = 0%), thromboembolic events (RR 1.11, 95% CI, 0.76-1.64; P = .59; I 2 = 0%), and all-cause mortality within 30 days (RR 1.03, 95% CI 0.73-1.45; P = .87; I 2 = 0%) were comparable between both groups.
Conclusion:
PCC significantly reduced the chest tube drainage output along with the number of RBC units transfused and the number of patients requiring RBC transfusion within the first 24 hours. In contrast, stroke, other thromboembolic events, and all-cause mortality were comparable between the 2 groups.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview