Use of factor concentrates for the management of perioperative bleeding: guidance from the SSC of the ISTH

Godiér, Anne; Greinacher, Andreas; Faraoni, David; Levy, Jerrold H.; Samama, Charles Marc

doi:10.1111/jth.13893

Cited by 37 publications

(33 citation statements)

References 30 publications

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“…The pathogenesis of bleeding in these situations is multifactorial, and patients often receive more than 1 form of therapy for correction of abnormalities. Thresholds have been defined by various guidelines for transfusion of plasma, PCC, platelets, cryoprecipitate, fibrinogen, and tranexamic acid . However, there are very few data available on the interaction between the various deficient components and TG and clot formation.…”

Section: Introductionmentioning

confidence: 99%

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Impaired platelet‐dependent thrombin generation associated with thrombocytopenia is improved by prothrombin complex concentrates in vitro

Chowdary

Hamid

Slatter

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Impaired thrombin generation (TG) in patients with acquired coagulopathy, is due to low coagulation factors and thrombocytopenia. The latter is typically treated with platelet transfusions and the former with plasma and occasionally with prothrombin complex concentrates (PCCs). We hypothesized that manipulating the concentrations of coagulation factors might result in restoration of platelet‐dependent TG over and above that of simple replacement therapy. Objective To investigate the influence of PCCs on impaired TG secondary to thrombocytopenia. Methods TG was evaluated by thrombin generation assay using a thrombocytopenia model in which normal plasma samples with varying platelet counts (20‐300 × 109/L) were spiked with PCCs (25%‐150% increase in plasma PCC levels). Results PCCs and platelets significantly increased TG in a dose‐dependent manner in vitro. Two‐way repeated measures of analysis of variance showed variance in peak height, area under the curve, time to peak, and velocity. This variance explained, respectively, by levels of PCC was 47, 59, 25 and 53%; by platelet count was 45, 28, 44, and 14%; by the combination was 80, 67, 70, and 62% variance; and a combination with additional interaction was 91, 84, 76, and 68%. TG at a platelet count 40 × 109/L with an approximate 25% increase in PCC concentration was similar to TG at 150 × 109/L. Similarly, patient samples spiked ex vivo with PCCs also showed highly significant improvements in TG. Conclusions Impaired TG of thrombocytopenia is improved by PCCs, supporting the need for additional studies in complex coagulopathies characterized by mild to moderate thrombocytopenia and abnormal coagulation.

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Section: Introductionmentioning

confidence: 99%

“…Thresholds have been defined by various guidelines for transfusion of plasma, PCC, platelets, cryoprecipitate, fibrinogen, and tranexamic acid. [2][3][4][5][6][7][8] However, there are very few data available on the interaction between the various deficient components and TG and clot formation.…”

Section: Introductionmentioning

confidence: 99%

Impaired platelet‐dependent thrombin generation associated with thrombocytopenia is improved by prothrombin complex concentrates in vitro

Chowdary

Hamid

Slatter

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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show abstract

“…Use of factor concentrates for the management of perioperative bleeding: reply. This issue, pp 2113-5.We read with interest the ISTH guideline by Godier et al on the use of factor concentrates for the management of perioperative bleeding [1]. The article raises a number of important points that we feel need further clarification.First, it refers to restoring hemostasis rather than maintaining hemostasis.…”

mentioning

confidence: 99%

“…We read with interest the ISTH guideline by Godier et al on the use of factor concentrates for the management of perioperative bleeding [1]. The article raises a number of important points that we feel need further clarification.…”

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confidence: 99%

Use of factor concentrates for the management of perioperative bleeding: comment

Sargant

Roy

Stanford

et al. 2018

Journal of Thrombosis and Haemostasis

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“…Whereas it is well known that fibrinogen is the first coagulation factor to fall to critically low levels during major hemorrhage, and that a decrease in fibrinogen concentration is a predictor of the severity of bleeding, it remains unproven whether administration of fibrinogen concentrates improves outcomes in the perioperative setting. Adequately powered trials performed in general surgery patients failed to support the systematic administration of fibrinogen [1,3]. Since the publication of our guidance document, a meta-analysis of eight randomized controlled trials performed in cardiovascular surgery confirmed that transfusion of fibrinogen concentrates did not reduce the rates of mortality or reoperation for bleeding [4].…”

mentioning

confidence: 99%

Use of factor concentrates for the management of perioperative bleeding: reply

Godiér

Greinacher

Faraoni

et al. 2018

Journal of Thrombosis and Haemostasis

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Use of factor concentrates for the management of perioperative bleeding: guidance from the SSC of the ISTH

Cited by 37 publications

References 30 publications

Impaired platelet‐dependent thrombin generation associated with thrombocytopenia is improved by prothrombin complex concentrates in vitro

Impaired platelet‐dependent thrombin generation associated with thrombocytopenia is improved by prothrombin complex concentrates in vitro

Use of factor concentrates for the management of perioperative bleeding: comment

Use of factor concentrates for the management of perioperative bleeding: reply

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