Prothrombin complex conc. overscores plasma for Post-cardiopulmonary bypass coagulopathy and bleeding

Prothrombin complex concentrate (PCC) is safe and efficacious to use over plasma in Post-cardiopulmonary bypass (CPB) coagulopathy and bleeding cases as per a recent study that was published in JAMA Surgery. There were fewer posttreatment intraoperative RBC transfusions, improved PT/INR correction, and a higher likelihood to avoid allogeneic transfusion in patients receiving PCCs. 

The most common reasons for blood product transfusion in surgical practices is the Post–cardiopulmonary bypass (CPB) coagulopathy and bleeding. Present retrospective data show lower rates of transfusions and also blood loss in patients receiving prothrombin complex concentrate (PCC) compared with plasma after cardiac surgery. Hence, researchers conducted a study to analyze perioperative bleeding and transfusion outcomes in patients undergoing cardiac surgery who develop microvascular bleeding and receive treatment with either PCC or plasma. 

A single-institution, prospective, randomized clinical trial was performed at a high-volume cardiac surgical center on patients who were aged 18 years or older and undergoing cardiac surgery with CPB. Patients undergoing complex cardiac surgical procedures like aortic replacement surgery, multiple procedures, or repeated sternotomy were given priority enrollment. During the study period, 756 patients were approached for enrollment, and 553 patients were randomized, and 100 patients met the criteria for study intervention. Patients with excessive microvascular bleeding, a prothrombin time (PT) greater than 16.6 seconds, and an international normalized ratio (INR) greater than 1.6 were randomized to receive treatment with either PCC or plasma. The PCC dose was 15 IU/kg or the closest standardized dose, and the plasma dose was a suggested volume of 10 to 15 mL/kg rounded to the nearest unit.