A Multicentre Observational Study of Prothrombin Complex Concentrate Therapy in Cardiac Surgery Patients - 22/01/26

Doi : 10.1016/j.hlc.2025.05.103

Yukiko Hikasa, MD, PhD ^a,^{^{1
Equal first authors}}, Anis Chaba, MD ^a,^b,^{^{1
Equal first authors},}^⁎ , Christine Culliver, BSc ^c, Emel Hasan, BSc ^c, Thien-Kim Vo, MD ^d, Fumitaka Yanase, MD, PhD ^b,^d, Sofia Spano, MD ^a, Akinori Maeda, MD ^a, Glenn Eastwood, PhD ^a, Nuanprae Kitisin, MD ^a,^e, Nattaya Raykateeraroj, MD ^a,^e, Nuttapol Pattamin, MD ^a, Atthaphong Phongphithakchai, MD ^a, Jonathan Nübel, MD ^a,^f, Alessandro Caroli, MD ^a, Gehan Premaratne, MD ^a,^g, Gabriel Chan ^a,^g, Joseph Furler ^a,^g, Andrew Motley, PGCipN ^h, Christopher Hogan, MD ^h, Laura Casteden, MD ⁱ, Rafaela Anja, PhD ⁱ, Jai Raman, MD ⁱ, Alastair Brown, MD ^d, Rinaldo Bellomo, MD, PhD ^a,^b,^g,^j

^a Department of Intensive Care, Austin Hospital, Melbourne, Vic, Australia

^b Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic, Australia

^c Dorevitch Blood Bank at Warringal Private Hospital, Melbourne, Vic, Australia

^d Department of Critical Care, St Vincent’s Hospital, Melbourne, Vic, Australia

^e Department of Anesthesia, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

^f Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Bernau, Germany

^g Department of Critical Care, The University of Melbourne, Melbourne, Vic, Australia

^h Department of Pathology and Transfusion Laboratory, Austin Hospital, Melbourne, Vic, Australia

ⁱ Department of Cardiothoracic Surgery, St Vincent’s Hospital, Melbourne, Vic, Australia

^j Data Analytics Research and Evaluation Centre, Austin Hospital, Vic, Melbourne, Australia

^∗ Corresponding author at: Department of Intensive Care, Austin Hospital, Melbourne, VIC 3084, Australia Department of Intensive Care Austin Hospital Melbourne Australia

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 22 January 2026

Abstract

Aim

This study aimed to assess the characteristics, transfusion events, and clinical outcomes of cardiac surgery patients treated with three-factor prothrombin complex concentrate (3F-PCC).

Method

A retrospective observational study was performed in three cardiac surgery centres in Australia. We studied sequential cardiac surgeries and collected data on 3F-PCC, fresh frozen plasma (FFP) and red blood cell (RBC) use from blood banks and clinical outcomes from the Australian Society of Cardiothoracic Surgery database. We compared 3F-PCC treated to PCC-untreated patients.

Results

For 1,698 patients, 254 (15%) received 3F-PCC, with a median dose of 2,000 IU (Interquartile range [IQR]: 1,000 to 2,000), administered almost exclusively in the operating theatre. After adjustment by overlap weighting, 3F-PCC was associated with a reduction in post-surgical FFP transfusions (Relative risk [RR]: 0.47; 95% confidence interval [CI] 0.29 to 0.77). Similarly, 14% of 3F-PCC patients needed ≥2 RBC units after surgery compared to 21% in controls (RR: 0.63; 95% CI 0.45 to 0.88). Both groups displayed similar safety profiles and clinical outcomes. However, pulmonary embolism occurred in 1.8% of 3F-PCC patients versus 0.8% of controls.

Conclusions

In a multicentre study, 3F-PCC use during cardiac surgery was independently associated with a significantly reduction of postoperative FFP and RBC transfusions. A phase III trial of early PCC at 2,000 IU appears justified.

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Keywords : Bleeding, Cardiac surgery, Fresh frozen plasma, Red blood cells, Transfusion, Prothrombin complex concentrate