Prothrombin Complex Concentrate versus Fresh Frozen Plasma in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) are commonly used to manage bleeding in patients during cardiac surgery. However, the relative efficacy and safety of these 2 strategies remain uncertain.

Methods: MEDLINE, Embase, and Cochrane were searched for studies comparing PCC and FFP in patients who underwent cardiac surgery complicated by bleeding. Review Manager (RevMan) ver. 5.4 (Nordic Cochrane Centre, The Cochrane Collaboration) was used for statistical analysis. Binary and continuous outcomes were compared using pooled risk ratios and mean differences, respectively. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews under protocol number CRD42022379144.

Results: We included 8 studies with 1,500 patients, of whom 613 (40.9%) received PCC. The mean follow-up period ranged from 28 to 90 days. The PCC group had significantly lower chest tube drainage at 24 hours (mean difference [MD], -148.50 mL; 95% CI, -253.02 to -43.99 mL; p=0.005; I²=42%). Fewer units of red blood cells (RBCs) were transfused within the first 24 hours (MD, -1.02 units; 95% CI, -1.81 to -0.24 units; p=0.01; I²=56%), and fewer patients required RBC transfusion within the first 24 hours (risk ratio, 0.85; 95% CI, 0.78-0.93; p<0.007; I²=45%) in the PCC group. There were no statistically significant differences in secondary outcomes. Nonetheless, a subgroup analysis of randomized controlled trials failed to corroborate the results obtained from the main analysis.

Conclusion: Our findings suggest that PCC can be effective, without increased adverse events, when compared with FFP in patients undergoing cardiac surgery complicated by bleeding.

Keywords: Hemorrhage; Meta-analysis; Plasma; Prothrombin complex concentrate; Thoracic surgery.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) screening and selection flow diagram for a study evaluating the effects of prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) in cardiac surgery.

Fig. 2

In an evaluation of the effects of prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) in cardiac surgery, there was a significant reduction in chest tube drainage output within 24 hours, favoring the PCC group. SD, standard deviation; IV, inverse variance; CI, confidence interval; RCT, randomized controlled trial; df, degrees of freedom. p-values <0.05 indicate statistical significance.

Fig. 3

The number of red blood cell (RBC) units transfused within the first 24 hours was significantly lower in the patients receiving prothrombin complex concentrate (PCC) during cardiac surgery when compared with fresh frozen plasma (FFP). SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom. p-values <0.05 indicate statistical significance.

Fig. 4

There was a significant decrease in the number of patients requiring red blood cell (RBC) transfusions within the first 24 hours after cardiac surgery, favoring patients who received prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) during surgery for coagulopathy or bleeding. M-H, Mantel-Haenszel; CI, confidence interval; RCT, randomized controlled trial; df, degrees of freedom. p-values <0.05 indicate statistical significance.

Fig. 5

There was no significant difference between groups for the incidence of stroke or transient ischemic attack after cardiac surgery when comparing patients who received prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) during surgery for bleeding or coagulopathy. M-H, Mantel-Haenszel; CI, confidence interval; RCT, randomized controlled trial; df, degrees of freedom. p-values <0.05 indicate statistical significance.

Fig. 6

There was no significant difference in the incidence of thromboembolic events after cardiac surgery between patients who received prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) during surgery for coagulopathy or bleeding. M-H, Mantel-Haenszel; CI, confidence interval; RCT, randomized controlled trial; df, degrees of freedom. p-values <0.05 indicate statistical significance.

Fig. 7

All-cause mortality within 30 days of cardiac surgery was not significantly different between patients who received prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) during surgery for coagulopathy or bleeding. M-H, Mantel-Haenszel; CI, confidence interval; RCT, randomized controlled trial; df, degrees of freedom. p-values <0.05 indicate statistical significance.