Nicholas Barker, BCCCP, PharmD, RPh
Clinical Pharmacy Coordinator - Critical Care
Emory Saint Joseph's Hospital
Atlanta, Georgia
Disclosure information not submitted.
Meera Patel, PharmD
Clinical Pharmacy Resident
Emory Saint Joseph's Hospital, United States
Disclosure information not submitted.
William Bender, MD, MPH
Assistant Professor of Medicine
Emory University School of Medicine, United States
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Sarah Burke, MD
Anesthesiologist
Department of Anesthesiology, Emory Saint Joseph's Hospital, United States
Disclosure information not submitted.
Title: Comparison of Prothrombin Complex Concentrate Dosing Strategies in Cardiothoracic Surgery Patients
Introduction: Patients commonly receive Fresh Frozen Plasma (FFP) and/or Prothrombin Complex Concentrate (PCC) for bleeding control to reduce the use of blood perioperative transfusions related to cardiothoracic surgery (CTS). Currently, no guidelines provide recommendations and dosing strategies are variable/limited. Patients at this institution prior to October 2019 received high dose (HD) PCC, defined as 25 units/kg IV. After October 2019, a dosing cap was implemented in which patients received a low-dose (LD) cap of PCC, defined as 15 units/kg IV.
Methods: This study was a single-center, retrospective chart review conducted at a 410-bed community tertiary care hospital, analyzing patients 18 years or older undergoing CTS who received PCC for presumed coagulopathy from May 1, 2019 – April 30th, 2020. Patients were evaluated pre and post dosing cap implementation. Patients were excluded from evaluation if they presented with a history of hypercoagulable conditions, anticoagulant use within 2 days, or pregnant patients and prisoners.
Results: A total of 96 patients were evaluated, 76 undergoing aortic surgeries. Baseline demographics and characteristics were similar among both groups. The primary outcome was difference in transfusion requirements. The HD group was associated with non-significantly higher red blood cell transfusions (10 vs. 8 units, p=0.18). Platelet and FFP requirements were significantly higher in the HD group (p= 0.026 and 0.014 respectively). There was no difference in cryoprecipitate needs (p=0.79). Chest tube output was also significantly higher in the HD group (p=0.034). Patients in the LD group received a median of 978 units less per dose (p< 0.01) which equates to an approximate cost savings of $1916 per dose. The HD group’s 30-day mortality was significantly higher (p=0.048). Thirteen patients in the HD group required exploratory surgery compared to none in the LD group. There was no difference in ICU and hospital length of stay (p= 0.74 and 0.41 respectively).
Conclusions: Based upon the results of this study, LD PCC may be a cost effective, safe alternative to HD PCC for CTS related coagulopathy. Higher blood product requirements were likely related to patients who required additional surgical intervention.