title: Use of prothrombin complex concentrate for excessive bleeding after cardiac surgery.
abstract: OBJECTIVE
  Prothrombin complex concentrates (PCCs) are sometimes used as 'off label' for excessive bleeding after cardiopulmonary bypass (CPB). The main objective of this study was to retrospectively evaluate the clinical and biological efficacy of PCC in this setting.
  
  
  METHODS
  We reviewed the charts of all patients who had undergone cardiac surgery under CPB in our institution for 2 years. Patients treated for active bleeding with haemostatic therapy were identified. Chest tube blood loss was quantified postoperatively in the first 24 h. Coagulation parameters were recorded at intensive care unit admission and in the patient's first 24 h. Thromboembolic complications were also ascertained.
  
  
  RESULTS
  Seventy-seven patients out of the 677 studied (11.4%) were included: PCC was solely administered in 24 patients (group I), fresh frozen plasma in 26 (group II) and both in 27 (group III). The mean dose of PCC was 10.0 UI/kg ± 3.5 for group I vs 14.1 UI/kg ± 11.2 for group III (P = 0.09). Initial blood loss in the first hour was different between the three groups (P = 0.05): 224 ± 131 ml for group I, 369 ± 296 ml for group II and 434 ± 398 ml for group III. Only group I vs group III presented a significant difference (P = 0.02). Variations of blood loss over time were no different according to the treatment groups (P = 0.12). Reductions in blood loss expressed in percentage showed no difference between the three groups after 2 h: 54.5% (68.6-30.8) for group I; 45.0% (81.6-22.2) for group II; 57.6 (76.0-2.1) for group III; (P = 0.89). Re-exploration for bleeding involved 1 patient in group I (4%), 2 in group II (8%) and 10 in group III (37%) (P = 0.002). Except for fibrinogen, variations of prothrombin time, activated partial thromboplastin time and platelets with time were not different according to the treatment groups. Cerebral infarction occurred in one patient in group II.
  
  
  CONCLUSIONS
  Administration of low-dose of PCC significantly decreased postoperative bleeding after CPB.
authors.affiliation: Cardiothoracic Intensive Care Unit,  Centre Chirurgical Marie Lannelongue, Le Plessis Robinson,  France.
authors.forename: Vrigina
authors.initials: V
authors.lastname: Arnékian
authors.forename: Julien
authors.initials: J
authors.lastname: Camous
authors.forename: Soly
authors.initials: S
authors.lastname: Fattal
authors.forename: Saida
authors.initials: S
authors.lastname: Rézaiguia-Delclaux
authors.forename: Rémi
authors.initials: R
authors.lastname: Nottin
authors.forename: François
authors.initials: F
authors.lastname: Stéphan
mesh_terms: D000368:Aged; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates