Abstract 16875: Prothrombin Complex Concentrate is Superior to Fresh Frozen Plasma for the Management of Bleeding in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

• Published in: Circulation (New York, N.Y.) Vol. 148; no. Suppl_1
• Main Authors: Viana, Patricia, Hoffmann Relvas, Jessica, Zanchi Persson, Marina, Dias Delfino Cabral, Thamiris, Sales de Oliveira, Jessica, Zanchi Persson, Jorge Eduardo, Bonow, Paulo A, Souza Freire, Camila Veronica, Velasquez, Camilo, Amaral, Sara
• Format: Journal Article
• Language: English
• Published: 07.11.2023
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.148.suppl_1.16875

Abstract only Introduction: Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) are commonly used for management of bleeding in cardiac surgery patients. However, the relative efficacy and safety of these two strategies remain uncertain. Hypothesis: We conducted a meta-analysis to compare outcomes of PCC vs. FFP in patients who undergo cardiac surgery complicated by bleeding. Methods: PubMed, Embase, and Cochrane were searched for studies comparing PCC vs. FFP in patients who have cardiac surgery complicated by bleeding. Review Manager 5.4 was used for statistical analysis. Binary and continuous outcomes were compared with pooled odds-ratio and mean differences, respectively. The meta-analysis protocol was registered prospectively in PROSPERO. Results: We included 8 studies with 1,500 patients, of whom 613 (40.9%) received PCC. The mean follow-up period ranged from 28-90 days. The PCC group had significantly lower chest tube drainage at 24 hours (MD -148.50 mL; 95% CI -253.02 to -43.99 mL; p = 0.005; I 2 = 42%; Figure 1A). Also, there were fewer units of RBC transfusion within the first 24 hours (MD -1.02 units; 95% CI -1.81 to -0.24 units; p = 0.01; I 2 = 56%; Figure 1B) and fewer patients requiring RBC transfusion within the first 24 hours (OR 0.38; 95% CI 0.28-0.52; p < 0.001; I 2 = 3%) in the PCC group. There was no significant difference between groups in all-cause mortality, thromboembolic events, stroke, or length of hospital stay. A subgroup analysis restricted to RCTs showed a significant reduction in the number of patients requiring RBC transfusion within 24 hours with PCC relative to FFP (OR 0.51; 95% CI 0.27-0.95; p = 0.04; I 2 = 0%). Conclusion: These findings suggest that PCC is an effective strategy compared with FFP in reducing chest tube drainage and the need for RBC transfusion within the first 24 hours in patients who undergo cardiac surgery complicated by bleeding, without a significant difference in mortality or thromboembolic events between groups.