The use of FEIBA for refractory bleeding in cardiac surgery - a systematic review

Khoury, William; Servito, Maria; Wang, Louie; Baranchuk, Adrián; Callum, Jeannie; Payne, Darrin; El‐Diasty, Mohammad

doi:10.1080/14779072.2022.2074838

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…According to the 2022 systematic review of FEIBA for refractory bleeding in adult cardiac surgery "… there is insufficient robust evidence to make a definitive conclusion about the safety or efficacy of using FEIBA as a hemostatic agent in the setting of cardiac surgery…." 18 Apart from the understandable scepticism related to the retrospective nature and small study sizes, the lack of statistically significant improvement in bleeding outcomes described above could also be attributed to "underdosing" FEIBA in the pediatric cardiac surgery setting because of fear of thromboses. It is still unknown if the dose of 10 to 15 U/kg of FEIBA (compared to 50-100 U/kg hemophiliac dose) derived from in vitro studies 19,20 is sufficient to boost coagulation cascade after CPB in vivo.…”

Section: Commentmentioning

confidence: 99%

“…A paucity of pediatric data prompted us to revisit the literature on the subject in the adult population. According to the 2022 systematic review of FEIBA for refractory bleeding in adult cardiac surgery “…there is insufficient robust evidence to make a definitive conclusion about the safety or efficacy of using FEIBA as a hemostatic agent in the setting of cardiac surgery….” 18…”

Section: Commentmentioning

confidence: 99%

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Activated Prothrombin Complex Concentrate in Pediatric Cardiac Patients, Our Early Experience

Ashikhmina Swan,

Brinkman,

Lahr

et al. 2023

World J Pediatr Congenit Heart Surg

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Background Pediatric cardiac surgery is associated with abnormal coagulation, bleeding, and nearly ubiquitous transfusions. With the popularization of patient blood management, attempts are being made to decrease liberal transfusions by administering prothrombin complex concentrates (PCCs). The safety and efficacy of PCCs in adult cardiac surgery has been studied extensively, but only few reports address this in children. We performed an observational study focused on transfusion requirements after off-label use of activated PCC Factor Eight Inhibitor Bypassing Activity (FEIBA) as an adjunct to post-cardiopulmonary bypass (CPB) hemostatic protocol. Methods We reviewed the medical records of children ≤15 kg undergoing cardiac operations with CPB between May 2018 and March 2022. A propensity score (PS) analysis was performed to identify matched pairs of patients who did and did not receive FEIBA. Results Out of 210 patients who met the inclusion criteria, 44 patients received FEIBA. Propensity score-based analysis identified 40 matched pairs of patients with similar baseline characteristics. There was no statistically significant difference in the primary outcome—the volume of transfusion after CPB, which included all allogeneic blood products and salvaged washed red cells administered after protamine. Specifically, FEIBA patients were transfused 28 (22-34) mL/kg and controls were transfused 22 (11-49) mL/kg, P = .989. Upon arrival to ICU, the FEIBA group averaged an 8% lower international normalized ratio, compared with the controls ( P = .009) and a 1.08 g/dL higher hemoglobin ( P = .050). Neither difference remained significant on POD 1. Conclusions In this exploratory study, we found no change in transfusion requirements after CPB despite FEIBA administration.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Activated Prothrombin Complex Concentrate in Pediatric Cardiac Patients, Our Early Experience

Ashikhmina Swan,

Brinkman,

Lahr

et al. 2023

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

show abstract

“…5 Like other PCCs, clinicians have used FEIBA off-label as a rescue therapy for coagulopathy unresponsive to conventional treatment, particularly in adult cardiac surgery. 6 However, unlike other PCCs, FEIBA contains the activated form of factor VII and a small amount of activated factor X. Because of this, there have been concerns, including a US Food and Drug Administration (FDA) package insert warning, regarding the potential of FEIBA for thromboembolic events.…”

mentioning

confidence: 99%