Department of Pathology, Montefiore Medical Center, Bronx, New York.
Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York.
Ann Thorac Surg. 2018 Apr;105(4):1152-1157. doi: 10.1016/j.athoracsur.2017.10.044. Epub 2018 Feb 15.
Left ventricular assist device (LVAD) recipients undergoing heart transplantation have increased bleeding risk. We compared conventional warfarin reversal with fresh frozen plasma vs 4-factor prothrombin complex concentrate (PCC) and the effect on transfusion requirements, blood bank costs, and clinical outcomes.
A retrospective review identified 60 consecutive LVAD recipients undergoing heart transplantation divided into two groups: 30 (no PCC) received fresh frozen plasma and 30 (PCC) received PCC. Patient characteristics, intraoperative and postoperative transfusion requirements, short-term clinical outcomes, and blood bank costs were compared. PCC association with transfusion requirements was assessed by multivariate linear regression.
Patients who received PCC were younger (50 ± 11 vs 57 ± 13 years, p = 0.02), fewer had ischemic cardiomyopathy (23% vs 60%, p = 0.01), had more than one prior sternotomy (7% vs 30%, p = 0.04), and had higher preoperative hemoglobin (11.8 ± 1.8 vs 10.4 ± 1.8 g/dL, p = 0.01). The PCC group had a significantly shorter bypass time (185 vs 217 minutes, p = 0.01), received less fresh frozen plasma (2 vs 5 units, p = 0.03), cryoprecipitate (0 vs 2 units, p = 0.05), and total blood products (9 vs 13.5 units, p = 0.03) intraoperatively, and was less likely to require delayed sternal closure (3% vs 23%, p = 0.05). On multivariate linear regression, PCC was significantly associated with decreased intraoperative transfusion (β = -6.09, p = 0.02). There was no difference in thromboembolic events or in-hospital death. Total blood bank costs were $4,949 for PCC and $3,677 for no PCC (p = 0.01).
Although more costly, PCC reduced transfusion requirements and delayed sternal closure in heart transplant recipients bridged with LVAD, justifying its use over traditional warfarin reversal.
接受左心室辅助装置 (LVAD) 治疗的患者在接受心脏移植后出血风险增加。我们比较了常规华法林逆转与新鲜冷冻血浆与 4 因子凝血酶原复合物浓缩物 (PCC) 的效果，以及对输血需求、血库成本和临床结果的影响。
回顾性分析了 60 例连续接受 LVAD 治疗的患者，将其分为两组：30 例（无 PCC）接受新鲜冷冻血浆，30 例（PCC）接受 PCC。比较患者特征、术中及术后输血需求、短期临床结果和血库成本。通过多元线性回归评估 PCC 与输血需求的关系。
接受 PCC 的患者年龄较小（50 ± 11 岁 vs 57 ± 13 岁，p = 0.02），缺血性心肌病比例较低（23% vs 60%，p = 0.01），有超过一次前正中切开史（7% vs 30%，p = 0.04），术前血红蛋白较高（11.8 ± 1.8 vs 10.4 ± 1.8 g/dL，p = 0.01）。PCC 组体外循环时间明显缩短（185 分钟 vs 217 分钟，p = 0.01），术中输注新鲜冷冻血浆（2 单位 vs 5 单位，p = 0.03）、冷沉淀（0 单位 vs 2 单位，p = 0.05）和总血制品（9 单位 vs 13.5 单位，p = 0.03）较少，更不可能需要延迟胸骨闭合（3% vs 23%，p = 0.05）。多元线性回归分析显示，PCC 与术中输血减少显著相关（β = -6.09，p = 0.02）。血栓栓塞事件或院内死亡无差异。PCC 的总血库成本为 4949 美元，无 PCC 的成本为 3677 美元（p = 0.01）。
尽管费用较高，但 PCC 可减少 LVAD 桥接心脏移植患者的输血需求和延迟胸骨闭合，证明其优于传统华法林逆转。
