Punzo Giovanni, Di Franco Valeria, Perilli Valter, Sacco Teresa, Sollazzi Liliana, Aceto Paola
Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
J Clin Med. 2023 May 29;12(11):3749. doi: 10.3390/jcm12113749.
The risk/benefit ratio of using prothrombin complex concentrates (PCCs) to correct coagulation defects in patients with end-stage liver disease is still unclear. The primary aim of this review was to assess the clinical effectiveness of PCCs in reducing transfusion requirements in patients undergoing liver transplantation (LT). This systematic review of non-randomized clinical trials was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was previously registered (PROSPERO:CRD42022357627). The primary outcome was the mean number of transfused units for each blood product, including red blood cells (RBCs), fresh frozen plasma, platelets, and cryoprecipitate. Secondary outcomes included the incidence of arterial thrombosis, acute kidney injury, and haemodialysis, and hospital and intensive care unit length of stay. There were 638 patients from 4 studies considered for meta-analysis. PCC use did not affect blood product transfusions. Sensitivity analysis, including only four-factor PCC, showed a significant reduction of RBC effect size (MD: 2.06; 95%CI: 1.27-2.84) with no true heterogeneity. No significant differences in secondary outcomes were detected. Preliminary evidence indicated a lack of PCC efficacy in reducing blood product transfusions during LT, but further investigation is needed. In particular, future studies should be tailored to establish if LT patients will likely benefit from four-factor PCC therapy.
使用凝血酶原复合物浓缩剂（PCCs）纠正终末期肝病患者凝血缺陷的风险/效益比仍不明确。本综述的主要目的是评估PCCs在减少肝移植（LT）患者输血需求方面的临床有效性。本对非随机临床试验的系统评价是根据系统评价和Meta分析的首选报告项目指南进行的。该方案先前已注册（国际前瞻性系统评价注册库：CRD42022357627）。主要结局是每种血液制品的平均输注单位数，包括红细胞（RBCs）、新鲜冰冻血浆、血小板和冷沉淀。次要结局包括动脉血栓形成、急性肾损伤和血液透析的发生率，以及住院时间和重症监护病房住院时间。纳入荟萃分析的4项研究中有638例患者。使用PCCs不影响血液制品的输注。敏感性分析（仅包括四因子PCC）显示红细胞效应量显著降低（MD：2.06；95%CI：1.27 - 2.84），且无真正的异质性。未检测到次要结局的显著差异。初步证据表明，PCCs在减少LT期间血液制品输注方面缺乏疗效，但仍需进一步研究。特别是，未来的研究应针对性地确定LT患者是否可能从四因子PCC治疗中获益。
