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A Multicentre Observational Study of Prothrombin Complex Concentrate Therapy in Cardiac Surgery Patients

Yukiko Hikasa1, Anis Chaba2, Christine Culliver3

  • 1Department of Intensive Care, Austin Hospital, Melbourne, Vic, Australia.

Heart, Lung & Circulation
|January 23, 2026
PubMed

Insights

Three-factor prothrombin complex concentrate (3F-PCC) use in cardiac surgery patients reduced the need for fresh frozen plasma and red blood cell transfusions. Early 3F-PCC administration at 2,000 IU warrants further investigation in clinical trials.

Area of Science:

  • Cardiology
  • Hematology
  • Transfusion Medicine

Background:

  • Cardiac surgery patients often require blood transfusions.
  • Managing perioperative bleeding is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the use and impact of three-factor prothrombin complex concentrate (3F-PCC) in cardiac surgery.
  • To assess transfusion requirements and clinical outcomes in patients treated with 3F-PCC.

Main Methods:

  • Retrospective observational study across three Australian cardiac surgery centers.
  • Data collected on 3F-PCC, fresh frozen plasma (FFP), and red blood cell (RBC) transfusions.
  • Comparison of outcomes between 3F-PCC treated and untreated patient groups.

Main Results:

  • 15% of 1,698 patients received 3F-PCC (median 2,000 IU).
  • 3F-PCC was linked to reduced postoperative FFP (RR 0.47) and RBC transfusions (RR 0.63).
  • Similar safety profiles, but higher pulmonary embolism rates in the 3F-PCC group (1.8% vs 0.8%).

Conclusions:

  • Multicenter data show 3F-PCC use is associated with significantly fewer postoperative FFP and RBC transfusions.
  • Early administration of 3F-PCC at 2,000 IU is supported by these findings.
  • A phase III trial is justified to confirm these results.
Abstract

Keywords:
BleedingCardiac surgeryFresh frozen plasmaProthrombin complex concentrateRed blood cellsTransfusion

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