Journal of Chest Surgery

  • 제57권1호
  • /
  • Pages.25-35
  • /
  • 2024
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지
DOI QR코드

DOI QR Code

Prothrombin Complex Concentrate versus Fresh Frozen Plasma in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

  • 투고 : 2023.06.29
  • 심사 : 2023.09.28
  • 발행 : 2024.01.05
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) are commonly used to manage bleeding in patients during cardiac surgery. However, the relative efficacy and safety of these 2 strategies remain uncertain. Methods: MEDLINE, Embase, and Cochrane were searched for studies comparing PCC and FFP in patients who underwent cardiac surgery complicated by bleeding. Review Manager (RevMan) ver. 5.4 (Nordic Cochrane Centre, The Cochrane Collaboration) was used for statistical analysis. Binary and continuous outcomes were compared using pooled risk ratios and mean differences, respectively. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews under protocol number CRD42022379144. Results: We included 8 studies with 1,500 patients, of whom 613 (40.9%) received PCC. The mean follow-up period ranged from 28 to 90 days. The PCC group had significantly lower chest tube drainage at 24 hours (mean difference [MD], -148.50 mL; 95% CI, -253.02 to -43.99 mL; p=0.005; I2 =42%). Fewer units of red blood cells (RBCs) were transfused within the first 24 hours (MD, -1.02 units; 95% CI, -1.81 to -0.24 units; p=0.01; I2 =56%), and fewer patients required RBC transfusion within the first 24 hours (risk ratio, 0.85; 95% CI, 0.78-0.93; p<0.007; I2 =45%) in the PCC group. There were no statistically significant differences in secondary outcomes. Nonetheless, a subgroup analysis of randomized controlled trials failed to corroborate the results obtained from the main analysis. Conclusion: Our findings suggest that PCC can be effective, without increased adverse events, when compared with FFP in patients undergoing cardiac surgery complicated by bleeding.

키워드

과제정보

We thank Dr. Rhanderson Cardoso for his assistance with methods, statistics, and paper revision.

참고문헌

  1. Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth 2017;61:760-7. https://doi.org/10.4103/ija.IJA_379_17 
  2. Thiele RH, Raphael J. A 2014 update on coagulation management for cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth 2014;18:177-89. https://doi.org/10.1177/1089253214534782 
  3. Karkouti K, Bartoszko J, Grewal D, et al. Comparison of 4-factor prothrombin complex concentrate with frozen plasma for management of hemorrhage during and after cardiac surgery: a randomized pilot trial. JAMA Netw Open 2021;4:e213936. https://doi.org/10.1001/jamanetworkopen.2021.3936 
  4. Green L, Roberts N, Cooper J, et al. Prothrombin complex concentrate vs. fresh frozen plasma in adult patients undergoing heart surgery: a pilot randomised controlled trial (PROPHESY trial). Anaesthesia 2021;76:892-901. https://doi.org/10.1111/anae.15327 
  5. Hashmi NK, Ghadimi K, Srinivasan AJ, et al. Three-factor prothrombin complex concentrates for refractory bleeding after cardiovascular surgery within an algorithmic approach to haemostasis. Vox Sang 2019;114:374-85. https://doi.org/10.1111/vox.12774 
  6. Tornkvist M, Smith JG, Labaf A. Current evidence of oral anticoagulant reversal: a systematic review. Thromb Res 2018;162:22-31. https://doi.org/10.1016/j.thromres.2017.12.003 
  7. Franchini M, Lippi G. Prothrombin complex concentrates: an update. Blood Transfus 2010;8:149-54. https://doi.org/10.2450/2010.0149-09 
  8. Ghadimi K, Levy JH, Welsby IJ. Prothrombin complex concentrates for bleeding in the perioperative setting. Anesth Analg 2016;122:1287-300. https://doi.org/10.1213/ANE.0000000000001188 
  9. Key NS, Negrier C. Coagulation factor concentrates: past, present, and future. Lancet 2007;370:439-48. https://doi.org/10.1016/S0140-6736(07)61199-4 
  10. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009 Jul 21;339:b2535. https://doi.org/10.1136/bmj.b2535 
  11. Arnekian V, Camous J, Fattal S, Rezaiguia-Delclaux S, Nottin R, Stephan F. Use of prothrombin complex concentrate for excessive bleeding after cardiac surgery. Interact Cardiovasc Thorac Surg 2012;15:382-9. https://doi.org/10.1093/icvts/ivs224 
  12. Cappabianca G, Mariscalco G, Biancari F, et al. Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery. Crit Care 2016;20:5. https://doi.org/10.1186/s13054-015-1172-6 
  13. Smith MM, Schroeder DR, Nelson JA, et al. Prothrombin complex concentrate vs plasma for post-cardiopulmonary bypass coagulopathy and bleeding: a randomized clinical trial. JAMA Surg 2022;157:757-64. https://doi.org/10.1001/jamasurg.2022.2235 
  14. Bartoszko J, Callum J, Karkouti K; FIBRES study investigators. The association of prothrombin complex concentrates with postoperative outcomes in cardiac surgery: an observational substudy of the FIBRES randomized controlled trial. Can J Anaesth 2021;68:1789-801. https://doi.org/10.1007/s12630-021-02100-4 
  15. Fitzgerald J, Lenihan M, Callum J, et al. Use of prothrombin complex concentrate for management of coagulopathy after cardiac surgery: a propensity score matched comparison to plasma. Br J Anaesth 2018;120:928-34. https://doi.org/10.1016/j.bja.2018.02.017 
  16. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. https://doi.org/10.1136/bmj.d5928 
  17. Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919. https://doi.org/10.1136/bmj.i4919 
  18. Higgins JP, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions: version 6.3. Cochrane; 2022. 
  19. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34. https://doi.org/10.1136/bmj.315.7109.629 
  20. Ortmann E, Besser MW, Sharples LD, et al. An exploratory cohort study comparing prothrombin complex concentrate and fresh frozen plasma for the treatment of coagulopathy after complex cardiac surgery. Anesth Analg 2015;121:26-33. https://doi.org/10.1213/ANE.0000000000000689 
  21. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008;36:2667-74. https://doi.org/10.1097/CCM.0b013e3181844677 
  22. Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007;116:2544-52. https://doi.org/10.1161/CIRCULATIONAHA.107.698977 
  23. Bhatt HV, Subramaniam K. PRO: prothrombin complex concentrate should be used in preference to fresh frozen plasma for hemostasis in cardiac surgical patients. J Cardiothorac Vasc Anesth 2018;32:1062-7. https://doi.org/10.1053/j.jvca.2017.05.044 
  24. Refaai MA, Goldstein JN, Lee ML, Durn BL, Milling TJ Jr, Sarode R. Increased risk of volume overload with plasma compared with four-factor prothrombin complex concentrate for urgent vitamin K antagonist reversal. Transfusion 2015;55:2722-9. https://doi.org/10.1111/trf.13191 
  25. Kohler M, Hellstern P, Lechler E, Uberfuhr P, Muller-Berghaus G. Thromboembolic complications associated with the use of prothrombin complex and factor IX concentrates. Thromb Haemost 1998;80:399-402. https://doi.org/10.1055/s-0037-1615219 
  26. Majeed A, Eelde A, Agren A, Schulman S, Holmstrom M. Thromboembolic safety and efficacy of prothrombin complex concentrates in the emergency reversal of warfarin coagulopathy. Thromb Res 2012;129:146-51. https://doi.org/10.1016/j.thromres.2011.07.024 
  27. Grottke O, Braunschweig T, Spronk HM, et al. Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury. Blood 2011;118:1943-51. https://doi.org/10.1182/blood-2011-03-343046 
  28. Roman M, Biancari F, Ahmed AB, et al. Prothrombin complex concentrate in cardiac surgery: a systematic review and meta-analysis. Ann Thorac Surg 2019;107:1275-83. https://doi.org/10.1016/j.athoracsur.2018.10.013