Many cardiopulmonary bypass surgery patients with coagulopathy and bleeding require post-operative plasma transfusions. Instead of plasma, the off-label use of prothrombin complex concentrates (PCC) has recently increased to treat coagulopathy and bleeding in cardiac surgery patients. PCC contains a higher concentration of coagulation factors in a much smaller volume, can be stored at room temperature, re-constituted quickly, carries a lower risk of transfusion-related complications, and does not need to be matched by ABO blood group. However, only retrospective studies have examined the safety and efficacy of PCC compared to plasma. Researchers at the Mayo Clinic examined perioperative bleeding and transfusion outcomes in 100 adult patients (98% white) undergoing post-cardiopulmonary bypass who developed coagulopathy and bleeding from 2016 to 2021—51 were randomized to PCC and 49 to plasma. Postoperative bleeding was similar in both groups—median chest tube output was 937 ml in the PCC group compared to 1022 ml in the plasma group. Furthermore, patients in the PCC group showed greater improvement in prothrombin time (PT) and international normalized ratios (INR) (P<0.001 for both), and fewer patients in the PCC group required RBC transfusions after treatment (P=0.04). Adverse events were similar in both groups. Results suggest a similar efficacy and safety profile for PCC and plasma in complex cardiac surgery patients, but additional research is needed.
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