Title: The Use of Three Factor Prothrombin Complex Concentrate to Reverse Warfarin Treated Mechanical Circulatory Device Patients Immediately Prior to Heart Transplant
Abstract: PurposeTo assess whether patients who are bridged to heart transplant by mechanical circulatory support (MCS) devices have lower incidences of bleeding and blood product transfusion when pre-treated with three factor prothrombin complex concentrate (PCC) immediately prior to heart transplant.MethodsThis study retrospectively reviews the effect that three factor PCC has on bleeding outcomes in anti-coagulated MCS patients going to transplant. The outcomes from 24 patients are described: 12 received PCC and 12 received usual care (fresh frozen plasma - FFP). Outcomes included packed red blood cell (RBC) transfusions as well as fresh frozen plasma or cryoprecipitate administration intra and post-operatively, Cell Saver amounts intra-operatively and chest tube outputs for the five days after transplant, thromboembolic events and INR value changes.ResultsTotal intra-operative PRBC transfusions were significantly lower in the PCC group (599.6 mL +/- 840 mL) compared to FFP group (1447.2 mL +/- 891.7 mL) p=0.018. Cell saver collections were concomitantly lower in the PCC group as well, (867.1mL +/- 496.7 mL vs. 1339.6 mL +/- 516.3 mL) p=0.032. The amount of additional reversal agents (FFP, cryoprecipitate, factor VIIa) was decreased in the PCC group. The chest tube outputs were not significantly different between groups for the five days following transplant surgery. The INR decrease between the PCC group and FFP group was not different. There were no differences in thromboembolic events. The average dose of PCC was 31 units/kg IV; repeat doses were given to 2 patients. There were no differences in the amount of vitamin K given between groups. Other significant differences between groups include more aprotinin use in the FFP group versus aminocaproic acid use in the PCC group. The significant differences in RBC use and bleeding indicators appeared intra-operatively and before post-operative day #1.ConclusionThe use of PCC on the day of heart transplant may lead to decreased blood loss and less blood transfusions intra-operatively. PurposeTo assess whether patients who are bridged to heart transplant by mechanical circulatory support (MCS) devices have lower incidences of bleeding and blood product transfusion when pre-treated with three factor prothrombin complex concentrate (PCC) immediately prior to heart transplant. To assess whether patients who are bridged to heart transplant by mechanical circulatory support (MCS) devices have lower incidences of bleeding and blood product transfusion when pre-treated with three factor prothrombin complex concentrate (PCC) immediately prior to heart transplant. MethodsThis study retrospectively reviews the effect that three factor PCC has on bleeding outcomes in anti-coagulated MCS patients going to transplant. The outcomes from 24 patients are described: 12 received PCC and 12 received usual care (fresh frozen plasma - FFP). Outcomes included packed red blood cell (RBC) transfusions as well as fresh frozen plasma or cryoprecipitate administration intra and post-operatively, Cell Saver amounts intra-operatively and chest tube outputs for the five days after transplant, thromboembolic events and INR value changes. This study retrospectively reviews the effect that three factor PCC has on bleeding outcomes in anti-coagulated MCS patients going to transplant. The outcomes from 24 patients are described: 12 received PCC and 12 received usual care (fresh frozen plasma - FFP). Outcomes included packed red blood cell (RBC) transfusions as well as fresh frozen plasma or cryoprecipitate administration intra and post-operatively, Cell Saver amounts intra-operatively and chest tube outputs for the five days after transplant, thromboembolic events and INR value changes. ResultsTotal intra-operative PRBC transfusions were significantly lower in the PCC group (599.6 mL +/- 840 mL) compared to FFP group (1447.2 mL +/- 891.7 mL) p=0.018. Cell saver collections were concomitantly lower in the PCC group as well, (867.1mL +/- 496.7 mL vs. 1339.6 mL +/- 516.3 mL) p=0.032. The amount of additional reversal agents (FFP, cryoprecipitate, factor VIIa) was decreased in the PCC group. The chest tube outputs were not significantly different between groups for the five days following transplant surgery. The INR decrease between the PCC group and FFP group was not different. There were no differences in thromboembolic events. The average dose of PCC was 31 units/kg IV; repeat doses were given to 2 patients. There were no differences in the amount of vitamin K given between groups. Other significant differences between groups include more aprotinin use in the FFP group versus aminocaproic acid use in the PCC group. The significant differences in RBC use and bleeding indicators appeared intra-operatively and before post-operative day #1. Total intra-operative PRBC transfusions were significantly lower in the PCC group (599.6 mL +/- 840 mL) compared to FFP group (1447.2 mL +/- 891.7 mL) p=0.018. Cell saver collections were concomitantly lower in the PCC group as well, (867.1mL +/- 496.7 mL vs. 1339.6 mL +/- 516.3 mL) p=0.032. The amount of additional reversal agents (FFP, cryoprecipitate, factor VIIa) was decreased in the PCC group. The chest tube outputs were not significantly different between groups for the five days following transplant surgery. The INR decrease between the PCC group and FFP group was not different. There were no differences in thromboembolic events. The average dose of PCC was 31 units/kg IV; repeat doses were given to 2 patients. There were no differences in the amount of vitamin K given between groups. Other significant differences between groups include more aprotinin use in the FFP group versus aminocaproic acid use in the PCC group. The significant differences in RBC use and bleeding indicators appeared intra-operatively and before post-operative day #1. ConclusionThe use of PCC on the day of heart transplant may lead to decreased blood loss and less blood transfusions intra-operatively. The use of PCC on the day of heart transplant may lead to decreased blood loss and less blood transfusions intra-operatively.