PROTHROMBIN COMPLEX CONCENTRATE VS FROZEN PLASMA FOR COAGULOPATHIC BLEEDING IN CARDIAC SURGERY : A SYSTEMATIC REVIEW META-ANALYSIS samuelfodop04@gmail.com

PW05-19

PROTHROMBIN COMPLEX CONCENTRATE VS FROZEN PLASMA FOR COAGULOPATHIC BLEEDING IN CARDIAC SURGERY : A SYSTEMATIC REVIEW META-ANALYSIS

5

Cameroon

Oral or Poster

Coagulopathic bleeding is a common complication of cardiac surgery as a result of depletion of enzymatic coagulation factors and subsequent impairment of thrombin generation. The mainstay of therapy for coagulopathic bleeding is fresh frozen plasma, and its use has been highly popularised despite a lack of compelling evidence to justify its effectiveness. Recent trials have proven the superiority of PCC in managing coagulopathic bleeding during cardiac surgery. To determine the most effective strategy, this systematic review and meta-analysis of randomised controlled trials comparing the effectiveness of PCC vs. FFP for coagulopathic bleeding in cardiac surgery was conducted.

PubMed, Embase, and the (CENTRAL) database were searched for randomized controlled trials that compared the effectiveness and safety of prothrombin complex concentrate vs frozen plasma in patients undergoing cardiac surgery.

Five randomized controlled trials (n=711 patients; 363 randomized to PCC) were included. PCC reduced the 24-hour chest tube output drainage (MD = –143.59 mL, 95% CI: –278.76 to –8.41; p = 0.04, moderate certainty) and a reduction in the number of RBC units transfused within 24 hours (MD = –0.93 units, 95% CI: –1.83 to –0.02; p = 0.05). For clinical outcomes, PCC use caused no difference in all-cause mortality (RR=0.81, 95% CI 0.57–1.15, moderate certainty), incidence of AKI (RR=0.86, 95% CI 0.43–1.70, high certainty), and the length of hospital stay (RR=-0.56, CI -1.73–0.61, moderate certainty).

Our findings suggest that PCC is superior to FFP in the management of coagulopathic bleeding in adult cardiac surgery without an increased risk of adverse effects.