Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation

Daniel H. Enter*, Anthony L. Zaki, Megan Marsh, Nikki Cool, Jane Kruse, Zhi Li, Adin-Cristian Andrei, Adam Iddriss, Patrick M McCarthy, S Chris Malaisrie, Allen Sawyer Anderson, Jonathan D Rich, Duc Thinh Pham

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Current practices for the reversal of warfarin before cardiac surgery include the use of vitamin K and fresh frozen plasma (FFP) to reduce the risk of bleeding. Although the 2010 International Society of Heart and Lung Transplantation guidelines acknowledge the use of prothrombin complex concentrate (PCC), there is no clear consensus on its efficacy. The objective of this study was to assess the efficacy of four-factor (4-F) PCC administration in patients requiring warfarin reversal before heart transplantation by determining blood product utilization perioperatively. Methods: Twenty-one patients who received 4-F PCC for warfarin reversal before heart transplantation were compared to a similar cohort of 39 patients who did not receive 4-F PCC, from January 2011 to July 2015. Blood product utilization was collected retrospectively for the 24-hour preoperative, intraoperative, and 48-hour postoperative periods. Results: Patients receiving 4-F PCC required fewer blood products in all three time periods. In the 24-hour preoperative period, 22 (56%) patients in the control group and 2 (10%) patients in the 4-F PCC groups received blood products (p<0.001). Intraoperatively, all patients received blood products. The 4-F PCC group required fewer units of packed red blood cells (median 3 vs 7 units, p<0.001) and FFP (median 4 vs 9 units, p<0.001). In the 48-hour postoperative period, 20 (51%) patients in the control group and 5 (24%) patients in the 4-F PCC group received blood products (p=0.04). Conclusions: 4-F PCC is associated with reduced blood product utilization 24 hours preoperatively and intraoperatively. Historically, the majority of patients require FFP for warfarin reversal preoperatively. In this single-center study, a significant reduction in the need for FFP was demonstrated with the use of 4-F PCC.

Original languageEnglish (US)
Pages (from-to)1215-1220
Number of pages6
JournalPharmacotherapy
Volume37
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Heart Transplantation
Warfarin
Blood Group Antigens
Postoperative Period
prothrombin complex concentrates
Heart-Lung Transplantation
Preoperative Period
Control Groups
Vitamin K
Thoracic Surgery
Erythrocytes
Guidelines
Hemorrhage

Keywords

  • heart transplantation
  • prothrombin complex concentrate
  • warfarin reversal

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

@article{bc58a88109404a2cb600259df545c490,
title = "Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation",
abstract = "Background: Current practices for the reversal of warfarin before cardiac surgery include the use of vitamin K and fresh frozen plasma (FFP) to reduce the risk of bleeding. Although the 2010 International Society of Heart and Lung Transplantation guidelines acknowledge the use of prothrombin complex concentrate (PCC), there is no clear consensus on its efficacy. The objective of this study was to assess the efficacy of four-factor (4-F) PCC administration in patients requiring warfarin reversal before heart transplantation by determining blood product utilization perioperatively. Methods: Twenty-one patients who received 4-F PCC for warfarin reversal before heart transplantation were compared to a similar cohort of 39 patients who did not receive 4-F PCC, from January 2011 to July 2015. Blood product utilization was collected retrospectively for the 24-hour preoperative, intraoperative, and 48-hour postoperative periods. Results: Patients receiving 4-F PCC required fewer blood products in all three time periods. In the 24-hour preoperative period, 22 (56{\%}) patients in the control group and 2 (10{\%}) patients in the 4-F PCC groups received blood products (p<0.001). Intraoperatively, all patients received blood products. The 4-F PCC group required fewer units of packed red blood cells (median 3 vs 7 units, p<0.001) and FFP (median 4 vs 9 units, p<0.001). In the 48-hour postoperative period, 20 (51{\%}) patients in the control group and 5 (24{\%}) patients in the 4-F PCC group received blood products (p=0.04). Conclusions: 4-F PCC is associated with reduced blood product utilization 24 hours preoperatively and intraoperatively. Historically, the majority of patients require FFP for warfarin reversal preoperatively. In this single-center study, a significant reduction in the need for FFP was demonstrated with the use of 4-F PCC.",
keywords = "heart transplantation, prothrombin complex concentrate, warfarin reversal",
author = "Enter, {Daniel H.} and Zaki, {Anthony L.} and Megan Marsh and Nikki Cool and Jane Kruse and Zhi Li and Adin-Cristian Andrei and Adam Iddriss and McCarthy, {Patrick M} and Malaisrie, {S Chris} and Anderson, {Allen Sawyer} and Rich, {Jonathan D} and Pham, {Duc Thinh}",
year = "2017",
month = "10",
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doi = "10.1002/phar.2015",
language = "English (US)",
volume = "37",
pages = "1215--1220",
journal = "Pharmacotherapy",
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publisher = "Pharmacotherapy Publications Inc.",
number = "10",

}

Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation. / Enter, Daniel H.; Zaki, Anthony L.; Marsh, Megan; Cool, Nikki; Kruse, Jane; Li, Zhi; Andrei, Adin-Cristian; Iddriss, Adam; McCarthy, Patrick M; Malaisrie, S Chris; Anderson, Allen Sawyer; Rich, Jonathan D; Pham, Duc Thinh.

In: Pharmacotherapy, Vol. 37, No. 10, 01.10.2017, p. 1215-1220.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation

AU - Enter, Daniel H.

AU - Zaki, Anthony L.

AU - Marsh, Megan

AU - Cool, Nikki

AU - Kruse, Jane

AU - Li, Zhi

AU - Andrei, Adin-Cristian

AU - Iddriss, Adam

AU - McCarthy, Patrick M

AU - Malaisrie, S Chris

AU - Anderson, Allen Sawyer

AU - Rich, Jonathan D

AU - Pham, Duc Thinh

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background: Current practices for the reversal of warfarin before cardiac surgery include the use of vitamin K and fresh frozen plasma (FFP) to reduce the risk of bleeding. Although the 2010 International Society of Heart and Lung Transplantation guidelines acknowledge the use of prothrombin complex concentrate (PCC), there is no clear consensus on its efficacy. The objective of this study was to assess the efficacy of four-factor (4-F) PCC administration in patients requiring warfarin reversal before heart transplantation by determining blood product utilization perioperatively. Methods: Twenty-one patients who received 4-F PCC for warfarin reversal before heart transplantation were compared to a similar cohort of 39 patients who did not receive 4-F PCC, from January 2011 to July 2015. Blood product utilization was collected retrospectively for the 24-hour preoperative, intraoperative, and 48-hour postoperative periods. Results: Patients receiving 4-F PCC required fewer blood products in all three time periods. In the 24-hour preoperative period, 22 (56%) patients in the control group and 2 (10%) patients in the 4-F PCC groups received blood products (p<0.001). Intraoperatively, all patients received blood products. The 4-F PCC group required fewer units of packed red blood cells (median 3 vs 7 units, p<0.001) and FFP (median 4 vs 9 units, p<0.001). In the 48-hour postoperative period, 20 (51%) patients in the control group and 5 (24%) patients in the 4-F PCC group received blood products (p=0.04). Conclusions: 4-F PCC is associated with reduced blood product utilization 24 hours preoperatively and intraoperatively. Historically, the majority of patients require FFP for warfarin reversal preoperatively. In this single-center study, a significant reduction in the need for FFP was demonstrated with the use of 4-F PCC.

AB - Background: Current practices for the reversal of warfarin before cardiac surgery include the use of vitamin K and fresh frozen plasma (FFP) to reduce the risk of bleeding. Although the 2010 International Society of Heart and Lung Transplantation guidelines acknowledge the use of prothrombin complex concentrate (PCC), there is no clear consensus on its efficacy. The objective of this study was to assess the efficacy of four-factor (4-F) PCC administration in patients requiring warfarin reversal before heart transplantation by determining blood product utilization perioperatively. Methods: Twenty-one patients who received 4-F PCC for warfarin reversal before heart transplantation were compared to a similar cohort of 39 patients who did not receive 4-F PCC, from January 2011 to July 2015. Blood product utilization was collected retrospectively for the 24-hour preoperative, intraoperative, and 48-hour postoperative periods. Results: Patients receiving 4-F PCC required fewer blood products in all three time periods. In the 24-hour preoperative period, 22 (56%) patients in the control group and 2 (10%) patients in the 4-F PCC groups received blood products (p<0.001). Intraoperatively, all patients received blood products. The 4-F PCC group required fewer units of packed red blood cells (median 3 vs 7 units, p<0.001) and FFP (median 4 vs 9 units, p<0.001). In the 48-hour postoperative period, 20 (51%) patients in the control group and 5 (24%) patients in the 4-F PCC group received blood products (p=0.04). Conclusions: 4-F PCC is associated with reduced blood product utilization 24 hours preoperatively and intraoperatively. Historically, the majority of patients require FFP for warfarin reversal preoperatively. In this single-center study, a significant reduction in the need for FFP was demonstrated with the use of 4-F PCC.

KW - heart transplantation

KW - prothrombin complex concentrate

KW - warfarin reversal

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