Lindsey Tincher, BCCCP, PharmD
New Hanover Regional Medical Center, North Carolina
Disclosure information not submitted.
Logan Doriety, PharmD
Clinical Pharmacist
New Hanover Regional Medical Center
Wilmington, North Carolina, United States
Disclosure information not submitted.
Courtney Olesky, PharmD
Clinical Pharmacist
Cabell Huntington Hospital, United States
Disclosure information not submitted.
Title: Evaluation of Clinical Outcomes of High-Dose vs. Low-Dose Kcentra in Cardiac Surgery Patients
Introduction: Cardiac surgery has one of the highest rates of blood cell transfusions; accounting for 10% of all PRBC transfusions. This is important as patient mortality is directly proportional to the number of units of PRBC transfused. When compared against FFP in cardiac surgery patients, a recent meta-analysis showed Kcentra administration was associated with reduced perioperative blood transfusions without adverse reactions. The dosing of Kcentra for cardiac surgery bleeding varies in the literature available. This study aimed to compare clinical outcomes of cardiovascular surgery patients receiving high dose (50 units/kg) vs. low dose (25 units/kg) of Kcentra in the perioperative and/or postoperative setting.
Methods: This was an IRB approved, retrospective, chart review within a community teaching hospital. Patients were included if they were at least 18 years old, underwent a coronary artery bypass graft, valve replacement, or mixed procedure, and received Kcentra for perioperative or postoperative for bleeding. Patients were excluded if they were older than 89 years or pregnant. The primary outcome was the prevalence of PRBC administration within 24 hours of Kcentra administration. Secondary outcomes included the prevalence of blood product administration, thromboembolic events, re-sternotomy, administration of additional Kcentra, thoracostomy tube output, length of stay, duration of mechanical ventilation, and cost of Kcentra therapy.
Results: Forty-seven of 69 patients screened met inclusion criteria. Twenty-seven patients received Kcentra 25 units/kg and 20 patients received Kcentra 50 units/kg. Baseline characteristics were similar among groups. Patients who received Kcentra 25 units/kg received a median of 3.0 units PRBC (IQR 0.5-6.6) and patients who received 50 units/kg received a median of 4.8 units (PRBC IQR 2.0-8.6). Twelve patients in the 25 units/kg group and 10 patients in the 50 units/kg group required a resternotomy. Thomboembolic events occurred in 3 vs. 1 patient in the 25 units/kg and 50 units/kg group respectively.
Conclusion: The Kcentra 25 units/kg group required fewer PRBC in the first 24 hrs after Kcentra administration. Additional studies are needed determine the optimal dosing strategy after cardiovascular surgery.