Fulminant Intraoperative Right Heart and Pulmonary Artery Thrombosis Following Prothrombin Complex Concentrate Infusion after Complex Open Heart Surgery with Cardiopulmonary Bypass

Koster, Andreas; Meyer-Jark, Ties; Schirmer, Uwe; Sandica, Eugene

doi:10.1097/acc.0b013e3182a070e9

Cited by 24 publications

(12 citation statements)

References 6 publications

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“…showed decreased blood loss only in the first hour in patients treated with PCC compared to FFP 26 . In comparison, we gave a slightly larger dose of PCC compared with Arnkian et al 26 [32][33][34][35] . Further study in a large prospective cohort is clearly required to determine whether rapid reversal of the INR as a result of warfarin is indeed offset by a potential increase of morbidity and mortality by thromboembolic events.…”

Section: Discussionmentioning

confidence: 59%

An Exploratory Cohort Study Comparing Prothrombin Complex Concentrate and Fresh Frozen Plasma for the Treatment of Coagulopathy After Complex Cardiac Surgery

Ortmann

Besser

Sharples

et al. 2015

Anesthesia &Amp; Analgesia

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Section: Discussionmentioning

confidence: 59%

An Exploratory Cohort Study Comparing Prothrombin Complex Concentrate and Fresh Frozen Plasma for the Treatment of Coagulopathy After Complex Cardiac Surgery

Ortmann

Besser

Sharples

et al. 2015

Anesthesia &Amp; Analgesia

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“…The uses of PCCs and fibrinogen concentrate have advantages over allogeneic plasma in its rapid availability and restoration of target factor(s) and lower risks for volume overload and TRALI [ 10 , 69 ]. However, there should be a careful consideration in the dosing of PCCs because the risk of thrombosis may be enhanced in a subset of trauma and surgical patients [ 70 ] due to circulating tissue factor [ 17 ] and decreased plasma or endothelial anticoagulant activity [ 71 ]. In the early phase of hemostatic therapy after massive hemorrhage, plasma transfusion can be used to sustain procoagulant and anticoagulant factor levels.…”

Section: Discussionmentioning

confidence: 99%

Role of prothrombin complex concentrate in perioperative coagulation therapy

2014

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Prothrombin complex concentrate (PCC) is a term to describe pharmacological products that contain lyophilized, human plasma-derived vitamin K-dependent factors (F), FII, FVII, FIX, FX, and various amounts of proteins C and S. PCCs can be rapidly reconstituted in a small volume (20 ml for about 500 international units (IU)) at bedside and administered regardless of the patient’s blood type. PCCs are categorized as 4-factor PCC if they contain therapeutic amounts of FVII, and 3-factor PCC when FVII content is low. In addition, activated PCC which contains activated FVII and FX with prothrombin is available for factor VIII bypassing therapy in hemophilia patients with inhibitors. Currently, 4-factor PCC is approved for the management of bleeding in patients taking warfarin, but there has been increasing use of various PCCs in the treatment of acquired perioperative coagulopathy unrelated to warfarin therapy and in the management of bleeding due to novel oral anticoagulants. There is also an ongoing controversy about plasma transfusion and its potential hazards including transfusion-related lung injury (TRALI). Early fixed ratio plasma transfusion has been implemented in many trauma centers in the USA, whereas fibrinogen concentrate and PCC are preferred over plasma transfusion in some European centers.In this review, the rationales for including PCCs in the perioperative hemostatic management will be discussed in conjunction with plasma transfusion.

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“…In comparison with rFVIIa, there is even less data regarding the use of PCCs in adults or children to treat post‐CPB bleeding. There are reports of thrombosis with PCC use in other clinical situations and post‐CPB . Although there are some preclinical data and case reports suggesting a benefit, further clinical studies are warranted to demonstrate efficacy and safety.…”

Section: Pediatric Heart Transplantationmentioning

confidence: 99%

Pediatric transplantation: managing bleeding

Raffini

Witmer

2015

Journal of Thrombosis and Haemostasis

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Summary. There has been extraordinary progress over the last half-century in the field of medical transplantation in which tissue, organs, or body parts from one human are placed into another. Solid organ transplants have allowed thousands of children with otherwise devastating inherited or acquired disorders to survive. Depending upon the clinical situation, there are many specific peri-transplant issues that must be carefully addressed to optimize outcomes. Although surgical, immunologic, and infectious concerns are usually in the forefront, important aspects regarding hemostasis frequently arise. The number of solid organs that can be successfully transplanted in children has expanded over the last decades and includes kidney, liver, heart, lung, intestine, pancreas, and thymus. Bleeding complications may occur in the setting of organ failure prior to transplantation, during the surgical procedure, or in the post-transplant setting, and can results in significant morbidity. This report will focus on preventing and managing non-surgical-related bleeding complications in children undergoing liver, heart, kidney transplantation, in whom there are often unique aspects of coagulation to be considered.

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Fulminant Intraoperative Right Heart and Pulmonary Artery Thrombosis Following Prothrombin Complex Concentrate Infusion after Complex Open Heart Surgery with Cardiopulmonary Bypass

Cited by 24 publications

References 6 publications

An Exploratory Cohort Study Comparing Prothrombin Complex Concentrate and Fresh Frozen Plasma for the Treatment of Coagulopathy After Complex Cardiac Surgery

An Exploratory Cohort Study Comparing Prothrombin Complex Concentrate and Fresh Frozen Plasma for the Treatment of Coagulopathy After Complex Cardiac Surgery

Role of prothrombin complex concentrate in perioperative coagulation therapy

Pediatric transplantation: managing bleeding

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