Budd Ashley N, Parulkar Suraj D, Carabini Louanne M, McCarthy Robert J
Department of Anesthesiology, Northwestern University Feinberg School of Medicine.
Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA.
Blood Coagul Fibrinolysis. 2025 Jan 1;36(1):18-25. doi: 10.1097/MBC.0000000000001335. Epub 2024 Nov 27.
The objective of this study was to compare total thromboembolic complications between 4-factor prothrombin complex concentrate (4F-PCC) with factor VIII inhibitor bypassing activity (FEIBA) when utilized during cardiac surgery.
A quasi-experimental analysis of retrospective data from consecutive patients.
A tertiary care university hospital.
Patients undergoing cardiac surgery with cardiopulmonary bypass.
Patients received either 4F-PCC or FEIBA after discontinuation of cardiopulmonary bypass and reversal of heparin with protamine.
Medical records were reviewed for thromboembolic events (stroke, arterial or venous thrombosis, pulmonary embolism, myocardial infarction), acute kidney injury, ischemic bowel, death, duration of intensive care unit and hospital stay, clinical and surgical characteristics and blood product utilization. A comparison of the clinical and surgical variables demonstrated a mean effect size of 0.33 imbalance between groups that was reduced to 0.18 after propensity score weighting. The propensity scores weighted analysis found an incidence of composite thromboembolic events of 39% in the 4F-PCC ( n = 90) and 47% in the FEIBA ( n = 50) group, difference -8 (-24% to 12%), P = 0.13. Individual thromboembolic events, acute kidney injury, ischemic bowel, mortality, and length of intensive care unit or hospital stay was not different among groups. Patients who received FEIBA had greater chest tube drainage and received more cryoprecipitate intraoperatively. Patients who received 4F-PCC received more fresh frozen plasma transfusions postoperatively.
Among cardiac surgery patients, there was no difference in thromboembolic events between patients who received 4F-PCC or FEIBA when used as an adjunct to blood product administration.
本研究的目的是比较心脏手术期间使用的含有凝血因子Ⅷ抑制物旁路活性的四因子凝血酶原复合物浓缩剂（4F-PCC）与活化凝血酶原复合物（FEIBA）之间的总血栓栓塞并发症。
对连续患者的回顾性数据进行准实验分析。
一家三级医疗大学医院。
接受体外循环心脏手术的患者。
患者在体外循环停止并用鱼精蛋白逆转肝素后接受4F-PCC或FEIBA。
查阅医疗记录以获取血栓栓塞事件（中风、动脉或静脉血栓形成、肺栓塞、心肌梗死）、急性肾损伤、缺血性肠病、死亡、重症监护病房和住院时间、临床和手术特征以及血液制品使用情况。临床和手术变量的比较显示，两组之间的平均效应大小为0.33的不平衡，在倾向评分加权后降至0.18。倾向评分加权分析发现，4F-PCC组（n = 90）的复合血栓栓塞事件发生率为39%，FEIBA组（n = 50）为47%，差异为-8（-24%至12%），P = 0.13。各组之间的个体血栓栓塞事件、急性肾损伤、缺血性肠病、死亡率以及重症监护病房或住院时间长度没有差异。接受FEIBA的患者胸腔引流更多，术中接受更多冷沉淀。接受4F-PCC的患者术后接受更多新鲜冰冻血浆输血。
在心脏手术患者中，当作为血液制品给药的辅助手段时，接受4F-PCC或FEIBA的患者之间的血栓栓塞事件没有差异。
