Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom.
Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu, Finland.
Ann Thorac Surg. 2019 Apr;107(4):1275-1283. doi: 10.1016/j.athoracsur.2018.10.013. Epub 2018 Nov 17.
Prothrombin complex concentrate (PCC) has recently emerged as an effective alternative to fresh frozen plasma (FFP) in treating excessive perioperative bleeding. This systematic review and meta-analysis evaluated the safety and efficacy of PCC administration as first-line treatment for coagulopathy after adult cardiac surgery.
PubMed/MEDLINE, EMBASE, and the Cochrane Library were searched from inception to the end of March 2018 to identify eligible articles. Adult patients undergoing cardiac surgery and receiving perioperative PCC were compared with patients receiving FFP.
A total of 861 adult patients from four studies were retrieved. No randomized studies were identified. Pooled odds ratios (ORs) showed that the PCC cohort was associated with a significant reduction in the risk of RBC transfusion (OR, 2.22; 95% confidence interval [CI], 1.45 to 3.40) and units of RBC received (OR, 1.34; 95% CI, 0.78 to 1.90). No differences were observed between the groups for reexploration for bleeding (OR, 1.09; 95% CI, 0.66 to 1.82), chest drain output at 24 hours (OR, 66.36; 95% CI, -82.40 to 216.11), hospital mortality (OR, 0.94; 95% CI, 0.59 to 1.49), stroke (OR, 0.80; 95% CI, 0.41 to 1.56), and occurrence of acute kidney injury (OR, 0.80; 95% CI, 0.58 to 1.12). A trend toward increased risk of renal replacement therapy was observed in the PCC group (OR, 0.41; 95% CI, 0.16 to 1.02).
In patients with significant bleeding after cardiac surgery, PCC administration seems to be more effective than FFP in reducing perioperative blood transfusions. No additional risks of thromboembolic events or other adverse reactions were observed. Randomized controlled trials are needed to establish the safety of PCC in cardiac surgery definitively.
凝血酶原复合物浓缩物（PCC）最近已成为治疗成人心脏手术后过度围手术期出血的新鲜冷冻血浆（FFP）的有效替代物。本系统评价和荟萃分析评估了 PCC 作为成人心脏手术后凝血功能障碍的一线治疗药物的安全性和有效性。
从开始到 2018 年 3 月底，通过 PubMed/MEDLINE、EMBASE 和 Cochrane 图书馆检索符合条件的文章。比较接受围手术期 PCC 治疗的成年心脏手术患者与接受 FFP 治疗的患者。
共检索到来自四项研究的 861 名成年患者。未发现随机研究。汇总优势比（OR）显示，PCC 组输血（OR，2.22；95%置信区间[CI]，1.45 至 3.40）和接受 RBC 单位（OR，1.34；95%CI，0.78 至 1.90）的风险显著降低。两组之间的再探查出血（OR，1.09；95%CI，0.66 至 1.82）、24 小时胸管引流量（OR，66.36；95%CI，-82.40 至 216.11）、住院死亡率（OR，0.94；95%CI，0.59 至 1.49）、中风（OR，0.80；95%CI，0.41 至 1.56）和急性肾损伤（OR，0.80；95%CI，0.58 至 1.12）无差异。PCC 组发生肾脏替代治疗的风险有增加的趋势（OR，0.41；95%CI，0.16 至 1.02）。
在心脏手术后出现大量出血的患者中，PCC 给药似乎比 FFP 更有效地减少围手术期输血。未观察到血栓栓塞事件或其他不良反应的风险增加。需要随机对照试验来明确 PCC 在心脏手术中的安全性。
