TY - JOUR
T1 - Prothrombin Complex Concentrates in Pediatric Cardiac Surgery
T2 - The Current State and the Future
AU - Ashikhmina, Elena
AU - Said, Sameh
AU - Smith, Mark M.
AU - Rodriguez, Vilmarie
AU - Oliver, William C.
AU - Nuttall, Gregory A.
AU - Dearani, Joseph A.
AU - Schaff, Hartzell V.
N1 - Publisher Copyright:
© 2017 The Society of Thoracic Surgeons
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/10
Y1 - 2017/10
N2 - Background After decades of practice of pediatric cardiac surgery, postoperative bleeding due to the immaturity of hemostasis, hemodilution, and hypothermia remains a concern. Recently, a new approach for adult coagulopathy after bypass has emerged. Prothrombin complex concentrates (PCCs), designed to treat bleeding in hemophilia patients, are safely and efficiently used off label for hemorrhage after bypass. However, optimal dosing, indications and contraindications, and laboratory tests to assess the efficacy of PCC use in children have not yet been established. This literature review outlines the challenges of bypass-related coagulopathy, the pharmacology, and the experience in use of PCCs, with a focus on their potential in pediatric cardiac surgery. Methods After a thorough literature search of MEDLINE, Scopus, and Ovid databases using the term “prothrombin complex concentrate AND pediatric,” 23 relevant articles were selected. Results The data supporting successful use of PCCs in acquired coagulopathy after cardiac surgery in adults have been increasing. Although small volume, low immunogenicity, efficiency, and speed in correcting coagulopathy are attractive qualities of PCCs for pediatric practice, current evidence is only anecdotal. The main concerns are unknown dosing regimens, the inability to closely monitor the effects of PCCs in real time, and a possibility of thrombotic complications, which can be particularly devastating in young congenital cardiac patients whose lives frequently depend upon the patency of artificial shunts. Conclusions Extensive, high-quality research is warranted to fill in the gaps of knowledge regarding using PCCs in pediatric cardiac practice.
AB - Background After decades of practice of pediatric cardiac surgery, postoperative bleeding due to the immaturity of hemostasis, hemodilution, and hypothermia remains a concern. Recently, a new approach for adult coagulopathy after bypass has emerged. Prothrombin complex concentrates (PCCs), designed to treat bleeding in hemophilia patients, are safely and efficiently used off label for hemorrhage after bypass. However, optimal dosing, indications and contraindications, and laboratory tests to assess the efficacy of PCC use in children have not yet been established. This literature review outlines the challenges of bypass-related coagulopathy, the pharmacology, and the experience in use of PCCs, with a focus on their potential in pediatric cardiac surgery. Methods After a thorough literature search of MEDLINE, Scopus, and Ovid databases using the term “prothrombin complex concentrate AND pediatric,” 23 relevant articles were selected. Results The data supporting successful use of PCCs in acquired coagulopathy after cardiac surgery in adults have been increasing. Although small volume, low immunogenicity, efficiency, and speed in correcting coagulopathy are attractive qualities of PCCs for pediatric practice, current evidence is only anecdotal. The main concerns are unknown dosing regimens, the inability to closely monitor the effects of PCCs in real time, and a possibility of thrombotic complications, which can be particularly devastating in young congenital cardiac patients whose lives frequently depend upon the patency of artificial shunts. Conclusions Extensive, high-quality research is warranted to fill in the gaps of knowledge regarding using PCCs in pediatric cardiac practice.
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U2 - 10.1016/j.athoracsur.2017.04.009
DO - 10.1016/j.athoracsur.2017.04.009
M3 - Review article
C2 - 28648539
AN - SCOPUS:85021149290
SN - 0003-4975
VL - 104
SP - 1423
EP - 1431
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -