Four-Factor Prothrombin Complex Concentrate in Left Ventricular Assist Device Implantation: Inverse Propensity Score-Weighted Analysis.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 07 2023
01 07 2023
Historique:
medline:
3
7
2023
pubmed:
6
5
2023
entrez:
5
5
2023
Statut:
ppublish
Résumé
We compare the effect of intraoperative administration of four-factor prothrombin complex concentrates (PCCs) versus fresh frozen plasma (FFP) on major bleeding, transfusions, and complications. Out of 138 patients undergoing left ventricle assist device (LVAD) implantation, 32 received PCCs as first-line hemostatic agents and 102 FFP (standard group). The crude treatment estimates indicated that, compared with the standard group, the PCC group required more FFP units (odds ratio [OR]: 4.17, 95% confidence interval [CI]: 1.58-11; p = 0.004) intraoperatively, whereas a greater number of patients received FFP at 24 hours (OR: 3.01, 95% CI: 1.19-7.59; p = 0.021) and less packed red blood cells (RBC) at 48 hours (OR: 0.61, 95% CI: 0.01-1.21; p = 0.046). After the inverse probability of treatment weighting (IPTW) adjusted analyses, in the PCC group there was still a higher number of patients who required FFP (OR: 2.9, 95% CI: 1.02-8.25; p = 0.048) or RBC (OR: 6.23, 95% CI: 1.67-23.14; p = 0.007] at 24 hours and RBC at 48 hours (OR: 3.09, 95% CI: 0.89-10.76; p = 0.007). Adverse events and survival were similar before and after the ITPW adjustment. In conclusion, the PCCs, although relatively safe with respect to thrombotic events, were not associated with a reduction of major bleeding and blood product transfusions.
Identifiants
pubmed: 37146590
doi: 10.1097/MAT.0000000000001974
pii: 00002480-202307000-00007
doi:
Substances chimiques
prothrombin complex concentrates
37224-63-8
Blood Coagulation Factors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e293-e300Informations de copyright
Copyright © ASAIO 2023.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Roger VL: Epidemiology of heart failure: A contemporary perspective. Circ Res 128: 1421–1434, 2021.
Guglin M: How to increase the utilization of donor hearts? Heart Fail Rev 20: 95–105, 2015.
Kirklin JK, Naftel DC, Pagani FD, et al.: Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant Off Publ Int Soc Heart Transplant 34: 1495–1504, 2015.
Lewin D, Nersesian G, Roehrich L, et al.: Impact of left ventricular inspection employing cardiopulmonary bypass on outcome after implantation of left ventricular assist device. Artif Organs 46: 908–921, 2022.
Molina EJ, Shah P, Kiernan MS, et al.: The Society of Thoracic Surgeons Intermacs 2020 annual report. Ann Thorac Surg 111: 778–792, 2021.
Ferraris VA, Brown JR, Despotis GJ, et al.; Society of Thoracic Surgeons Blood Conservation Guideline Task Force: 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 91: 944–982, 2011.
Clifford L, Jia Q, Subramanian A, et al.: Characterizing the epidemiology of postoperative transfusion-related acute lung injury. Anesthesiology 122: 12–20, 2015.
Kilic A, Whitman GJR: Blood transfusions in cardiac surgery: Indications, risks, and conservation strategies. Ann Thorac Surg 97: 726–734, 2014.
Holcomb JB, Tilley BC, Baraniuk S, et al.; PROPPR Study Group: Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs. a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA 313: 471–482, 2015.
Piffard M, Nubret-Le Coniat K, Simon O, et al.: Independent risk factors for ICU mortality after left ventricular assist device implantation. Artif Organs 44: 153–161, 2020.
Schaffer JM, Arnaoutakis GJ, Allen JG, et al.: Bleeding complications and blood product utilization with left ventricular assist device implantation. Ann Thorac Surg 91: 740–747; discussion 747, 2011.
Murphy GJ, Reeves BC, Rogers CA, Rizvi SIA, Culliford L, Angelini GD: Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 116: 2544–2552, 2007.
Haglund NA, Davis ME, Tricarico NM, et al.: Perioperative blood product use: A comparison between HeartWare and HeartMate II devices. Ann Thorac Surg 98: 842–849, 2014.
Hong Y, Dufendach K, Wang Y, Thoma F, Kilic A: Impact of early massive transfusion and blood component ratios in patients undergoing left ventricular assist device implantation. J Card Surg 36: 4519–4526, 2021.
Chai-Adisaksopha C, Hillis C, Siegal DM, et al.: Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal: A systematic review and meta-analysis. Thromb Haemost 116: 879–890, 2016.
Pandey S, Vyas GN: Adverse effects of plasma transfusion. Transfusion (Paris) 52: 65S–79S, 2012.
Mehra MR, Uber PA, Uber WE, Scott RL, Park MH: Allosensitization in heart transplantation: Implications and management strategies. Curr Opin Cardiol 18: 153–158, 2003.
Percy CL, Hartmann R, Jones RM, et al.: Correcting thrombin generation ex vivo using different haemostatic agents following cardiac surgery requiring the use of cardiopulmonary bypass. Blood Coagul Fibrinolysis Int J Haemost Thromb 26: 357–367, 2015.
Cappabianca G, Mariscalco G, Biancari F, et al.: Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery. Crit Care Lond Engl 20: 5, 2016.
Jennings DL, Rimsans J, Connors JM: Prothrombin complex concentrate for warfarin reversal in patients with continuous-flow left ventricular assist devices: A narrative review. ASAIO J 66: 482–488, 2020.
Smith MM, Schroeder DR, Nelson JA, et al.: Prothrombin complex concentrate vs. plasma for post-cardiopulmonary bypass coagulopathy and bleeding: A randomized clinical trial. JAMA Surg 157: 757–764, 2022.
Boswell MR, Stulak JM, Tchantchaleishvili V, et al.: Intraoperative prothrombin complex concentrate administration and outcomes in patients undergoing left ventricular assist device implantation. Artif Organs 45: E223–E303, 2021.
Bradford CD, Stahovich MJ, Dembitsky WP, Adamson RM, Engelbert JJ, Perreiter AS: Safety of prothombin complex concentrate to control excess bleeding during continuous flow LVAD insertion. ASAIO J 61: 509–513, 2015.
Ghadimi K, Levy JH, Welsby IJ: Prothrombin complex concentrates for bleeding in the perioperative setting. Anesth Analg 122: 1287–1300, 2016.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J Clin Epidemiol 61: 344–349, 2008.
Monaco F, Nardelli P, Denaro G, et al.: First experience with a ROTEM-enhanced transfusion algorithm in patients undergoing aortic arch replacement with frozen elephant trunk technique: A theranostic approach to patient blood management. J Clin Anesth 66: 109910, 2020.
Buuren S van, Groothuis-Oudshoorn K: mice: Multivariate imputation by chained equations in R. J Stat Softw 45: 1–67, 2011.
Austin PC, Stuart EA: Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34: 3661–3679, 2015.
Mitra R, Reiter JP: A comparison of two methods of estimating propensity scores after multiple imputation. Stat Methods Med Res 25: 188–204, 2016.
Austin PC: Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat: Simul Comput 38: 1228–1234, 2009.
Rohde JM, Dimcheff DE, Blumberg N, et al.: Health care-associated infection after red blood cell transfusion: A systematic review and meta-analysis. JAMA 311: 1317–1326, 2014.
Pagano D, Milojevic M, Meesters MI, et al.: 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg 53: 79–111, 2018.
Fitzgerald J, Lenihan M, Callum J, et al.: Use of prothrombin complex concentrate for management of coagulopathy after cardiac surgery: A propensity score matched comparison to plasma. Br J Anaesth 120: 928–934, 2018.
Quader M, LaPar DJ, Wolfe L, et al.: Blood product utilization with left ventricular assist device implantation: A decade of statewide data. ASAIO J 62: 268–273, 2016.
Miller RJH, Gregory AJ, Kent W, Banerjee D, Hiesinger W, Clarke B: Predicting transfusions during left ventricular assist device implant. Semin Thorac Cardiovasc Surg 32: 747–755, 2020.
Quader M, LaPar DJ, Wolfe L, et al.: Delayed sternal closure after continuous flow left ventricle assist device implantation: Analysis of risk factors and impact on outcomes and costs. ASAIO J 62: 432–437, 2016.
Goudie R, Sterne JC, Verheyden V, Bhabra M, Ranucci M, Murphy GJ: Risk scores to facilitate preoperative prediction of transfusion and large volume blood transfusion associated with adult cardiac surgery. Br J Anaesth 114: 757–766, 2015.
Austin PC: A tutorial and case study in propensity score analysis: An application to estimating the effect of in-hospital smoking cessation counseling on mortality. Multivar Behav Res 46: 119–151, 2011.
Karkouti K, Bartoszko J, Grewal D, et al.: Comparison of 4-factor prothrombin complex concentrate with frozen plasma for management of hemorrhage during and after cardiac surgery: A randomized pilot trial. JAMA Netw Open 4: e213936, 2021.