Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/30802
Title: Immediate Higher-Dose Prothrombin Complex Concentrate Without Fresh Frozen Plasma or Fibrinogen Concentrate for Significant Coagulopathic Cardiac Surgical Field Bleeding.
Austin Authors: Pruthi, Prashant;Culliver, Christine;Emel, Hasan;Georghie, Sophie;Benson, Matthew J;Matalanis, George ;Yanase, Fumitaka ;Bellomo, Rinaldo 
Affiliation: Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Vic, Australia
Department of Critical Care, University of Melbourne, Melbourne, Vic, Australia
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic, Australia
Intensive Care Unit, Warringal Private Hospital, Melbourne, Vic, Australia
Dorevitch Blood Bank at Warringal Private Hospital, Melbourne, Vic, Australia
Department of Anaesthesia, Warringal Private Hospital, Melbourne, Vic, Australia
Department of Cardiac Surgery, Warringal Private Hospital, Melbourne, Vic, Australia
Intensive Care
Issue Date: Sep-2022
metadata.dc.date: 2022
Publication information: Heart, Lung & Circulation 2022-09; 31(9): 1300-1306
Abstract: Treatment of significant coagulopathic cardiac surgical field bleeding with immediate higher-dose prothrombin complex concentrate (PCC) without fresh frozen plasma (FFP) or fibrinogen concentrate is unexplored. To study characteristics, chest drainage, and clinical outcomes of patients with significant coagulopathic surgical field bleeding treated with immediate higher-dose (defined at >15 IU/kg based on factor IX) PCC without FFP or fibrinogen concentrate. We screened sequential cardiac surgery patients. We reviewed electronic blood bank data, Australian Society of Cardiothoracic Surgery database information and anaesthetic, intensive care unit (ICU), ward and radiological charts and electronic data. We identified patients deemed by the operating surgeon to require treatment for significant coagulopathic surgical field bleeding who underwent immediate higher-dose PCC without FFP or fibrinogen concentrate. Among 168 patients, we identified 30 who underwent immediate higher-dose PCC without FFP or fibrinogen concentrate. Median age was 68 years, 23 were male, 17 underwent coronary artery bypass surgery and three underwent complex surgery (David procedure, redo mitral valve surgery, and redo thoraco-abdominal aneurysm repair). Median dose of PCC was 2,500 IU. In addition, 27% underwent platelets and one underwent cryoprecipitate. Chest drainage at 24 hours was 505 ml. Survival to hospital discharge was 100%. There were no cases of pulmonary embolism, stroke, or other thrombotic events. Stage 1 AKI occurred in one patient. In a pilot cohort of patients with significant coagulopathic surgical field bleeding, immediate higher-dose PCC without FFP or fibrinogen concentrate was feasible and had an acceptable efficacy and safety profile, which justifies future controlled studies.
URI: https://ahro.austin.org.au/austinjspui/handle/1/30802
DOI: 10.1016/j.hlc.2022.05.048
PubMed URL: 35843859
Type: Journal Article
Subjects: Chest tube drainage
Coagulopathic cardiac surgical field bleeding
Prothrombin complex concentrate
Thrombo-embolic complications
Appears in Collections:Journal articles

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