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A European consensus statement on the use of four-factor prothrombin complex concentrate for cardiac and non-cardiac surgical patients

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  • G Erdoes
  • E Ortmann
  • M I Meesters
  • D Bolliger
  • E Baryshnikova
  • B Martinez Lopez De Arroyabe
  • A Ahmed
  • M D Lance
  • M Ranucci
  • C von Heymann
  • S Agarwal
  • H B Ravn
Vis graf over relationer

Modern four-factor prothrombin complex concentrate was designed originally for rapid targeted replacement of the coagulation factors II, VII, IX and X. Dosing strategies for the approved indication of vitamin K antagonist-related bleeding vary greatly. They include INR and bodyweight-related protocols as well as fixed dose regimens. Particularly in the massively bleeding trauma and cardiac surgery patient, four-factor prothrombin complex concentrate is used increasingly for haemostatic resuscitation. Members of the Transfusion and Haemostasis Subcommittee of the European Association of Cardiothoracic Anaesthesiology performed a systematic literature review on four-factor prothrombin complex concentrate. The available evidence has been summarised for dosing, efficacy, drug safety and monitoring strategies in different scenarios. Whereas there is evidence for the efficacy of four-factor prothrombin concentrate for a variety of bleeding scenarios, convincing safety data are clearly missing. In the massively bleeding patient with coagulopathy, our group recommends the administration of an initial bolus of 25 IU.kg-1 . This applies for: the acute reversal of vitamin K antagonist therapy; haemostatic resuscitation, particularly in trauma; and the reversal of direct oral anticoagulants when no specific antidote is available. In patients with a high risk for thromboembolic complications, e.g. cardiac surgery, the administration of an initial half-dose bolus (12.5 IU.kg-1 ) should be considered. A second bolus may be indicated if coagulopathy and microvascular bleeding persists and other reasons for bleeding are largely ruled out. Tissue-factor-activated, factor VII-dependent and heparin insensitive point-of-care tests may be used for peri-operative monitoring and guiding of prothrombin complex concentrate therapy.

OriginalsprogEngelsk
TidsskriftAnaesthesia
Vol/bind76
Udgave nummer3
Sider (fra-til)381-392
Antal sider12
ISSN0003-2409
DOI
StatusUdgivet - mar. 2021

Bibliografisk note

© 2020 Association of Anaesthetists.

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