Sun Gina H, Patel Visal, Moreno-Duarte Ingrid, Zahedi Farhad, Ursprung Eric, Couper Greg, Chen Fred Y, Welsby Ian J, Comenzo Raymond, Kao Grace, Cobey Frederick C
Tufts University School of Medicine, Boston, MA.
Tufts Medical Center, Department of Anesthesiology and Perioperitive Medicine, Boston, MA.
J Cardiothorac Vasc Anesth. 2018 Feb;32(1):161-167. doi: 10.1053/j.jvca.2017.08.011. Epub 2017 Aug 3.
Assessing the efficacy of intraoperative 4-factor prothrombin complex concentrate (4F-PCC) use in blood product utilization, time to chest closure, intensive care unit (ICU) and hospital length of stay (LOS), thromboembolic complications, renal injury and mortality in left ventricular assist device (LVAD) patients on home anticoagulation therapy with warfarin, undergoing orthotopic heart transplantation (OHT).
Retrospective analysis of OHT patients at Tufts Medical Center from May 2013 to October 2016.
Single-institution, university hospital setting.
Patients with preexisting LVADs who received orthotopic heart transplants (n = 74; 32 patients 4F-PCC, 42 patients no 4F-PCC).
Warfarin reversal using 4F-PCC in patients with LVADs undergoing orthotopic heart transplantation with the 4F-PCC dosing partitioned such that one-third was given pre-CPB and two-thirds were given post-CPB.
The 4F-PCC group required less plasma (6 [IQR 4] v 1.31 [IQR 2] U, p < 0.001), cryoprecipitate (10 [IQR 10] v 7.50 [IQR 5] U, p < 0.001), and packed red blood cells (5 [IQR 4] v 2 [IQR 1.5] U, p < 0.001) and had a shorter time to chest closure (618.8 ± 111.4 v 547.9 ± 110.1 minutes, p = 0.008). There was no difference in platelet transfusion (2 [IQR 1] v 2 [IQR 1] U, p = 0.16), ICU or hospital LOS, acute kidney injury, or mortality. No thrombotic complications occurred.
Replacing plasma with 4F-PCC to reverse preoperative warfarin anticoagulation during OHT was associated with a shorter time to chest closure and less blood product utilization, without an increase in acute kidney injury, thromboembolic complications, or death.
评估术中使用四因子凝血酶原复合物浓缩剂（4F-PCC）对接受原位心脏移植（OHT）且正在接受华法林家庭抗凝治疗的左心室辅助装置（LVAD）患者的血液制品使用情况、关胸时间、重症监护病房（ICU）住院时间和医院住院时间（LOS）、血栓栓塞并发症、肾损伤及死亡率的影响。
对2013年5月至2016年10月在塔夫茨医学中心接受OHT的患者进行回顾性分析。
单机构大学医院环境。
已植入LVAD并接受原位心脏移植的患者（n = 74；32例患者使用4F-PCC，42例患者未使用4F-PCC）。
在接受原位心脏移植的LVAD患者中使用4F-PCC进行华法林逆转，4F-PCC的给药分为两部分，三分之一在体外循环前给予，三分之二在体外循环后给予。
4F-PCC组所需的血浆（6 [四分位间距4] 单位对1.31 [四分位间距2] 单位，p < 0.001）、冷沉淀（10 [四分位间距10] 单位对7.50 [四分位间距5] 单位，p < 0.001）和红细胞悬液（5 [四分位间距4] 单位对2 [四分位间距1.5] 单位，p < 0.001）更少，关胸时间更短（618.8 ± 111.4分钟对547.9 ± 110.1分钟，p = 0.008）。血小板输注（2 [四分位间距1] 单位对2 [四分位间距1] 单位，p = 0.16）、ICU或医院住院时间、急性肾损伤或死亡率无差异。未发生血栓栓塞并发症。
在OHT期间用4F-PCC替代血浆以逆转术前华法林抗凝与关胸时间缩短和血液制品使用减少相关，且急性肾损伤、血栓栓塞并发症或死亡未增加。
