Dosing, Monitoring, Blood Product Utilization, and Thromboembolic Complications of Four-Factor Prothrombin Complex Concentrate as Part of an Institutional Protocol in Pediatric Cardiac Surgery: A Retrospective Cohort Study

Amy L. Kiskaddon; Neil A. Goldenberg; Jamie L. Fierstein; Alexandra Miller; James A. Quintessenza; Vyas M. Kartha

doi:10.1055/s-0043-1777301

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2024; 50(06): 873-882
DOI: 10.1055/s-0043-1777301

Review Article

Dosing, Monitoring, Blood Product Utilization, and Thromboembolic Complications of Four-Factor Prothrombin Complex Concentrate as Part of an Institutional Protocol in Pediatric Cardiac Surgery: A Retrospective Cohort Study

Amy L. Kiskaddon

¹Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

²Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland

³Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

⁴Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

,

Neil A. Goldenberg

³Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

⁵Division of Hematology, Departments of Medicine and Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland

⁶Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

,

Jamie L. Fierstein

⁷Epidemiology and Biostatistics Shared Resource, Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

,

Alexandra Miller

⁷Epidemiology and Biostatistics Shared Resource, Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

,

James A. Quintessenza

⁴Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

,

Vyas M. Kartha

⁸Department of Anesthesiology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

⁹Division of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland

› Author Affiliations

Abstract

Pediatric cardiac surgery patients are predisposed to blood loss. Blood product administration can lead to complications. Prothrombin complex concentrates (PCCs) offer potential advantages of factor composition, small volume, decreased immunogenicity/infectious risks, and accessibility. The objective of this study was to describe dosing, monitoring, blood product utilization, and thromboembolic complications of administering four-factor PCC (4F-PCC) in pediatric cardiac surgery. We performed a retrospective review of patients aged <18 years undergoing cardiac surgery from June 2020 to May 2022 (inclusive) who received 4F-PCC. Outcomes of interest included 4F-PCC dosing (units/kg) and number of doses administered, chest tube output, blood product administration, donor exposure, length of stay, and thromboembolic events. Eighty-six patients met eligibility criteria. The median (range) age and weight were 0.37 (0.01–16.3) years and 5.3 (1.6–98) kg, respectively. Median (range) total 4F-PCC dose per patient was 25 (9.2–50) units/kg, with 6 patients (7%) receiving a total of two doses. Median (range) 24-hour postoperative packed red blood cells, platelet, plasma, and cryoprecipitate administration volumes were 0 (0–2.57) mL/kg/24 h, 0 (0–1.09), 0 (0–2.64), and 0 (0–0.28 mL/kg/24 h), respectively. Median (range) length of stay and 24-hour postoperative chest tube output were 10 (6–26) days and 1.1 (0.1–4.2) mL/kg/h, respectively. Two (2%) patients experienced a thromboembolic event within 30 days of 4F-PCC administration. These retrospective findings suggest no worsening of hemostatic parameters, a mild median improvement in fibrinogen, low blood product utilization, and low thromboembolism rates following 4F-PCC use in pediatric cardiac surgery.

Keywords

4F-PCC - pediatric - cardiac surgery - bleeding - thrombosis

Full Text

References

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