Prothrombin Complex Concentrates Effective Option To Plasma
Post–cardiopulmonary bypass (CPB) coagulopathy and bleeding are among the most common reasons for blood product transfusion in surgical practices. A single-institution, prospective, randomized clinical trial performed at a high-volume cardiac surgical center. Of the 553 randomized patients, 100 patients met criteria for study intervention. 100 patients (mean [SD] age, 66.8 [13.7] years; 61 [61.0%] male; and 1 [1.0%] Black, 1 [1.0%] Hispanic, and 98 [98.0%] White) received the study intervention (49 plasma and 51 PCC). There was no significant difference in chest tube output between the plasma and PCC groups. After treatment, patients in the PCC arm had a greater improvement in PT (effect estimate, 1.37 seconds [95% CI, 1.91 to 0.84]; P<.001) and INR (effect estimate, 0.12 [95% CI, 0.16 to 0.07]; P<.001). Fewer patients in the PCC group required intraoperative RBC transfusion after treatment (7 of 51 patients [13.7%] vs 15 of 49 patients [30.6%]; P=.04). Seven (13.7%) of 51 patients receiving PCCs avoided allogeneic transfusion from the intraoperative period to the end of postoperative day 1 vs none of those receiving plasma. There were no significant differences in postoperative bleeding, transfusions, or adverse events.