Cardiac Surgery, Northwestern University, Chicago, Illinois.
Pharmacy, Northwestern University, Chicago, Illinois.
Pharmacotherapy. 2017 Oct;37(10):1215-1220. doi: 10.1002/phar.2015.
Current practices for the reversal of warfarin before cardiac surgery include the use of vitamin K and fresh frozen plasma (FFP) to reduce the risk of bleeding. Although the 2010 International Society of Heart and Lung Transplantation guidelines acknowledge the use of prothrombin complex concentrate (PCC), there is no clear consensus on its efficacy. The objective of this study was to assess the efficacy of four-factor (4-F) PCC administration in patients requiring warfarin reversal before heart transplantation by determining blood product utilization perioperatively.
Twenty-one patients who received 4-F PCC for warfarin reversal before heart transplantation were compared to a similar cohort of 39 patients who did not receive 4-F PCC, from January 2011 to July 2015. Blood product utilization was collected retrospectively for the 24-hour preoperative, intraoperative, and 48-hour postoperative periods.
Patients receiving 4-F PCC required fewer blood products in all three time periods. In the 24-hour preoperative period, 22 (56%) patients in the control group and 2 (10%) patients in the 4-F PCC groups received blood products (p<0.001). Intraoperatively, all patients received blood products. The 4-F PCC group required fewer units of packed red blood cells (median 3 vs 7 units, p<0.001) and FFP (median 4 vs 9 units, p<0.001). In the 48-hour postoperative period, 20 (51%) patients in the control group and 5 (24%) patients in the 4-F PCC group received blood products (p=0.04).
4-F PCC is associated with reduced blood product utilization 24 hours preoperatively and intraoperatively. Historically, the majority of patients require FFP for warfarin reversal preoperatively. In this single-center study, a significant reduction in the need for FFP was demonstrated with the use of 4-F PCC.
在心脏手术前逆转华法林的当前实践包括使用维生素 K 和新鲜冷冻血浆（FFP）来降低出血风险。尽管 2010 年国际心肺移植学会指南承认使用凝血酶原复合物浓缩物（PCC）的作用，但对于其疗效尚无明确共识。本研究的目的是通过确定心脏移植前华法林逆转患者围手术期血液制品的使用情况，评估四因子（4-F）PCC 给药在需要逆转华法林的患者中的疗效。
将 2011 年 1 月至 2015 年 7 月期间接受 4-F PCC 逆转华法林的 21 例心脏移植患者与未接受 4-F PCC 的 39 例相似患者进行比较。回顾性收集 24 小时术前、术中及术后 48 小时的血液制品使用情况。
接受 4-F PCC 的患者在所有三个时间段内所需的血液制品均较少。在 24 小时术前期间，对照组中有 22 例（56%）患者和 4-F PCC 组中有 2 例（10%）患者接受了血液制品（p<0.001）。术中所有患者均接受了血液制品。4-F PCC 组所需的单位红细胞（中位数 3 比 7 单位，p<0.001）和 FFP（中位数 4 比 9 单位，p<0.001）更少。在术后 48 小时期间，对照组中有 20 例（51%）患者和 4-F PCC 组中有 5 例（24%）患者接受了血液制品（p=0.04）。
4-F PCC 与术前 24 小时和术中血液制品的使用减少相关。在历史上，大多数患者需要 FFP 来逆转术前的华法林。在这项单中心研究中，使用 4-F PCC 显著减少了对 FFP 的需求。
