Prothrombin Complex Concentrate in Cardiac Surgery: A Systematic Review and Meta-Analysis
Autor: | Aamer Ahmed, Leon Hadjinikolaou, Aung Oo, Seema Agarwal, Geoff Tsang, Fausto Biancari, Giovanni Mariscalco, Francesco Santini, Ali Al-Sarraf, Marius Roman, Mark Field |
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Rok vydání: | 2018 |
Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Postoperative Hemorrhage surgical blood loss Risk Assessment coagulopathy law.invention 03 medical and health sciences Plasma 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Coagulopathy Humans Renal replacement therapy Blood Coagulation Factors Cardiac Surgical Procedures Female Prognosis Treatment Outcome Stroke business.industry Odds ratio Perioperative medicine.disease Prothrombin complex concentrate prothrombin complex concentrate 030228 respiratory system Surgery Fresh frozen plasma Cardiology and Cardiovascular Medicine business cardiac surgery medicine.drug |
Zdroj: | The Annals of thoracic surgery. 107(4) |
ISSN: | 1552-6259 |
Popis: | Background Prothrombin complex concentrate (PCC) has recently emerged as an effective alternative to fresh frozen plasma (FFP) in treating excessive perioperative bleeding. This systematic review and meta-analysis evaluated the safety and efficacy of PCC administration as first-line treatment for coagulopathy after adult cardiac surgery. Methods PubMed/MEDLINE, EMBASE, and the Cochrane Library were searched from inception to the end of March 2018 to identify eligible articles. Adult patients undergoing cardiac surgery and receiving perioperative PCC were compared with patients receiving FFP. Results A total of 861 adult patients from four studies were retrieved. No randomized studies were identified. Pooled odds ratios (ORs) showed that the PCC cohort was associated with a significant reduction in the risk of RBC transfusion (OR, 2.22; 95% confidence interval [CI], 1.45 to 3.40) and units of RBC received (OR, 1.34; 95% CI, 0.78 to 1.90). No differences were observed between the groups for reexploration for bleeding (OR, 1.09; 95% CI, 0.66 to 1.82), chest drain output at 24 hours (OR, 66.36; 95% CI, −82.40 to 216.11), hospital mortality (OR, 0.94; 95% CI, 0.59 to 1.49), stroke (OR, 0.80; 95% CI, 0.41 to 1.56), and occurrence of acute kidney injury (OR, 0.80; 95% CI, 0.58 to 1.12). A trend toward increased risk of renal replacement therapy was observed in the PCC group (OR, 0.41; 95% CI, 0.16 to 1.02). Conclusions In patients with significant bleeding after cardiac surgery, PCC administration seems to be more effective than FFP in reducing perioperative blood transfusions. No additional risks of thromboembolic events or other adverse reactions were observed. Randomized controlled trials are needed to establish the safety of PCC in cardiac surgery definitively. |
Databáze: | OpenAIRE |
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