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

Q4 Medicine Journal of Chest Surgery Pub Date : 2024-01-05 Epub Date: 2023-11-23 DOI:10.5090/jcs.23.081
Patricia Viana, Jessica Hoffmann Relvas, Marina Persson, Thamiris Dias Delfino Cabral, Jorge Eduardo Persson, Jessica Sales de Oliveira, Paulo Bonow, Camila Veronica Souza Freire, Sara Amaral
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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.

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凝血酶原复合物浓缩物与新鲜冷冻血浆在接受心脏手术的成人患者中的应用:一项系统综述和荟萃分析。
背景:凝血酶原复合物浓缩物(PCC)和新鲜冷冻血浆(FFP)通常用于心脏手术患者出血的处理。然而,这两种策略的相对疗效和安全性仍不确定。方法:检索MEDLINE、Embase和Cochrane,比较心脏手术合并出血患者PCC和FFP的研究。审查管理器(RevMan)版本。5.4 (Nordic Cochrane Centre, The Cochrane Collaboration)进行统计分析。分别使用合并风险比和平均差异比较二元和连续结局。该荟萃分析方案已在国际前瞻性系统评价登记册上注册,协议号为CRD42022379144。结果:我们纳入了8项研究,共1500例患者,其中613例(40.9%)接受了PCC。平均随访时间28 ~ 90天。PCC组24小时胸管引流明显降低(平均差[MD], -148.50 mL;95% CI, -253.02 ~ -43.99 mL;p = 0.005;I2 = 42%)。前24小时内输血的红细胞(红细胞)单位较少(MD, -1.02单位;95% CI, -1.81 ~ -0.24单位;p = 0.01;I2=56%),并且在最初24小时内需要输血的患者较少(风险比,0.85;95% ci, 0.78-0.93;p2=45%)。在次要结局方面没有统计学上的显著差异。然而,随机对照试验的亚组分析未能证实主分析得出的结果。结论:我们的研究结果表明,与FFP相比,PCC在心脏手术合并出血患者中是有效的,且没有增加不良事件。
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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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