Lee Jennifer, Rivero Andrea, Renew J Ross, Spaulding Aaron, Borkar Shalmali, Mckenzie Ian, Davey Kuki, Ladlie Beth
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, Jacksonville, FL.
Division of Health Care Delivery Research, Mayo Clinic Florida, Jacksonville, FL.
Transplant Direct. 2024 May 16;10(6):e1637. doi: 10.1097/TXD.0000000000001637. eCollection 2024 Jun.
Four-factor prothrombin complex concentrate (PCC) is a plasma product that contains factors II, VII, IX, X, protein C, and protein S. PCC can be used off-label to treat coagulopathy during orthotopic liver transplantation (OLT). However, its use comes with safety concerns regarding thrombosis. The purpose of our study is to determine the safety of PCC in OLT.
We conducted a retrospective cohort study of patients who received 4-factor PCC during OLT at our institution from January 1, 2018, to May 1, 2022, with a 1:1 match of 83 patients who received PCC and 83 patients who did not. We evaluated 30-d mortality, 1-y mortality, prevalence of thrombotic complications (portal vein thrombosis, deep venous thrombosis, myocardial infarction, and pulmonary embolus), and postoperative intensive care (ICU) length of stay (LOS).
There was no significant difference in 30-d mortality (odds ratio [OR] 5; 95% confidence interval [CI], 0.58-42.8; = 0.14), 1-y mortality (OR 3; 95% CI, 0.61-14.86; = 0.18), or ICU LOS (OR -13.8; 95% CI, -39.2 to 11.6; = 0.29). There was no increased incidence of thrombotic complications among patients receiving PCC 90 d after surgery, including portal vein thrombosis (OR 1.5; 95% CI, 0.42-5.32; = 0.53), pulmonary embolus (OR 1; 95% CI, 0.14-7.1; = 0.99), deep venous thrombosis (OR 0.67; 95% CI, 0.11-3.99; = 0.66), and myocardial infarction (OR 1.67; 95% CI, 0.4-6.97; = 0.48).
Although there was a statistically insignificant increase in mortality after PCC administration during OLT, we did not see a significant increase in perioperative complications, including thrombotic events and increased ICU LOS.
四因子凝血酶原复合物浓缩剂（PCC）是一种血浆制品，含有因子II、VII、IX、X、蛋白C和蛋白S。PCC可用于原位肝移植（OLT）期间治疗凝血功能障碍的超说明书用药。然而，其使用存在血栓形成方面的安全隐患。我们研究的目的是确定PCC在OLT中的安全性。
我们对2018年1月1日至2022年5月1日在我院接受OLT期间使用四因子PCC的患者进行了一项回顾性队列研究，将83例接受PCC的患者与83例未接受PCC的患者按1:1配对。我们评估了30天死亡率、1年死亡率、血栓形成并发症（门静脉血栓形成、深静脉血栓形成、心肌梗死和肺栓塞）的发生率以及术后重症监护病房（ICU）住院时间（LOS）。
30天死亡率（比值比[OR]5；95%置信区间[CI]，0.58 - 42.8；P = 0.14）、1年死亡率（OR 3；95% CI，0.61 - 14.86；P = 0.18）或ICU住院时间（OR -13.8；95% CI，-39.2至11.6；P = 0.29）无显著差异。术后90天内接受PCC的患者血栓形成并发症发生率没有增加，包括门静脉血栓形成（OR 1.5；95% CI，0.42 - 5.32；P = 0.53）、肺栓塞（OR 1；95% CI，0.14 - 7.1；P = 0.99）、深静脉血栓形成（OR 0.67；95% CI，0.11 - 3.99；P = 0.66）和心肌梗死（OR 1.67；95% CI，0.4 - 6.97；P = 0.48）。
虽然OLT期间使用PCC后死亡率有统计学上无显著意义的增加，但我们未观察到围手术期并发症有显著增加，包括血栓形成事件和ICU住院时间延长。
