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Coagulopathy in Cardiac Surgery: A Scoping Review of Prothrombin Complex Concentrate
Stanislaw Vander Zwaag1, Imre Kukel1, Jens Fassl1
1Institute of Cardiac Anaesthesiology, Heart Centre and Medical Faculty, TUD Dresden University of Technology, Dresden, Germany.
Heart, Lung & Circulation
|June 19, 2026
Summary
Four-factor prothrombin complex concentrate (PCC) effectively reduces bleeding and transfusion needs after cardiac surgery compared to fresh frozen plasma (FFP). However, optimal dosing and timing remain unclear, necessitating further research.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Hematology
- Cardiovascular Surgery
Background:
- Post-cardiopulmonary bypass coagulopathy increases bleeding, transfusion needs, and mortality.
- Fresh frozen plasma (FFP) is traditional, but four-factor prothrombin complex concentrate (PCC) is an emerging alternative.
Purpose of the Study:
- To systematically review evidence on the efficacy, safety, and optimal use of four-factor PCC in adult cardiac surgery.
- Identify knowledge gaps regarding dosing, timing, cost-effectiveness, and safety of PCC.
Main Methods:
- A comprehensive scoping review following PRISMA-ScR guidelines.
- Systematic search of multiple databases without language or date restrictions.
- Independent data extraction and charting by two blinded reviewers.
Main Results:
- PCC consistently reduces postoperative chest tube output and transfusion requirements versus FFP.
- Dosing varied widely (500-4000 IU fixed or 15-30 IU/kg weight-based).
- Viscoelastic testing guides use, but standardized thresholds are absent; PCC may be cost-effective and safe.
Conclusions:
- Significant evidence gaps exist for optimal PCC dose, timing, viscoelastic targets, and sequencing with fibrinogen concentrate.
- Further high-quality randomized trials are essential to refine clinical guidelines for PCC in cardiac surgery.
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