Perioperative Factor Concentrate Use is Associated With More Beneficial Outcomes and Reduced Complication Rates Compared With a Pure Blood Product–Based Strategy in Patients Undergoing Elective Cardiac Surgery: A Propensity Score–Matched Cohort Study

Abstract

Objective: The goal of this study was to compare factor concentrate (FC)Àbased and blood productÀbased hemostasis management of coagulopathy in cardiac surgical patients in terms of postoperative bleeding, required blood products, and outcome. Design: Retrospective, propensity scoreÀmatched analysis. Setting: Single, tertiary, academic medical center. Participants: One hundred eighteen matched pairs of 433 consecutive patients scheduled for cardiac surgery in two isolated periods with distinct strategies of hemostasis management. Interventions: Patients received either blood productÀbased (period I) or FC-based (period II) hemostasis management to treat perioperative coagulopathy. Measurements and Main Results: Patients treated with FC management experienced less postoperative blood loss (907 v 1,153 mL, p = 0.014) and required less red blood cell and fresh frozen plasma transfusion (2.3 v 3.7 units p < 0.0001, and 2.0 v 3.4 units p < 0.0001, respectively) compared with subjects in the blood productÀbased management group. The frequency of Stage 3 acute kidney injury and 30-day mortality rate were significantly higher in the blood productÀbased group than in the FC management group (6.8% v 0.8%, p = 0.016, and 7.2% v 0.8%, p = 0.022, respectively). FC management-related thromboembolic events were not registered. The FC strategy was associated with a 2.19-fold decrease in the odds of massive postoperative bleeding (p < 0.0001), a 2.56-fold decrease in the odds of polytransfusion (p < 0.0001), and a 13.16-fold decrease in the odds of early postoperative death (p = 0.003).

Challenges in Patient Blood Management for Cardiac Surgery: A Narrative Review

“…Ref. [ 96 ] A total of 118 matched patients were compared for transfusion requirements, postoperative blood loss, the need for reintervention, duration of postoperative ventilation, acute kidney injury, stroke, new onset atrial fibrillation, postoperative myocardial infarction, thromboembolic events, infectious complications, length of stay and 30-day mortality.…”