Treating bleeding during cardiac surgery: Is prothrombin complex concentrate a substitute for plasma?

What is this research about?

During cardiac surgery patients may experience a disruption in their coagulation system (ability to form blood clots). This causes excessive bleeding. Managing bleeding and improving clotting in these patients requires that insufficient levels of an enzyme called thrombin, which helps form blood clots, be replenished.

A number of clotting factors need to be present in blood to improve thrombin generation. Frozen plasma (FP), which contains clotting factors, is used in Canada to manage clot formation in cardiac patients despite the lack of data supporting its effectiveness and risk of causing adverse transfusion reactions, particularly heart failure. Prothrombin complex concentrates (PCCs), which contain selected clotting factors, may be a potential alternative to FP in the management of bleeding. PCCs have multiple advantages since they do not require ABO blood type matching, are provided in lower volumes (lower risk of adverse transfusion reactions) and are pathogen-reduced (lower risk of transfusion-transmitted infections). However, PCCs do not contain the full complement of procoagulants and anticoagulants that are present in FP and may carry a higher thrombotic risk.

A pilot study in bleeding patients undergoing cardiac surgery was conducted to compare PCC and FP in terms of safety and bleeding management effects and to assess the feasibility of a larger trial.

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