OC 48.2 - Dosing, Monitoring, Blood Product Utilization, and Thromboembolic Complications of Four Factor Prothrombin Complex Concentrate: A Retrospective Cohort Study

Background: Pediatric cardiac surgery patients are predisposed to blood loss given an immature hemostatic system, hemodilution and coagulopathy. blood product administration leads to immune reactivity, transfusion related circulatory overload and lung injury. Prothrombin complex concentrates (PCCs) are advantageous given factor composition, small volume, decreased immunogenicity/infectious risks, and accessibility.

Aims: Describe dosing, monitoring, blood product utilization, and thromboembolic complications of four factor prothrombin complex concentrate (4F-PCC) in pediatric cardiac surgery.

Methods: A retrospective review of patients age < 18 years undergoing cardiac surgery from June 2020 to May 2022 (inclusive) who received 4F-PCC according to an institutional transfusion algorithm. Dosing included 4F-PCC dose (units/kg), and total doses administered. Additionally, chest tube output, blood product administration, length of stay, thromboembolic event during encounter and re-admission within 30 days were recorded. Descriptive statistics summarized demographics and clinical outcomes. Continuous variables were reported as medians (range), categorical variables as frequencies and percentages. Differences in pre-vs. post-4F-PCC laboratory monitoring tests were evaluated via Wilcoxon-signed rank test.

Results: Ninety patients age < 18 years met eligibility criteria. Median age and weight were 0.4(0.01-16.3) years and 5.9(1.6-98) kg, respectively. Surgical complexity included: 28(31.1%) STAT 1, 21(23.3%) STAT 2, 23(25.6%) STAT 3, 6(6.7%) STAT 4, and 9(10%) STAT 5. No patients had thrombus history. Median PCC dose was 25 (9.2-50) units/kg, and 6.7% (n=6) patients received a 2nd dose. Total intraoperative PRBC, platelets, plasma and cryoprecipitate were 74.4(7.4-367.5)mL/kg, 19.8(5.3-59.5)mL/kg, 54.5(9.8-190.4)mL/kg, and 5.8(0.8-21.5) mL/kg, respectively. Median pre- and post-4F-PCC were significantly different: INR (p=.0002), fibrinogen (p=.008), TEGly30 (p <.0001), and prothrombin time (p=.0001). Median chest tube output 24 hours post ICU admission was 1.02 (0.06-5.2) mL/kg/hr. One (1.3%) patients experienced a thromboembolic event.

Conclusion(s): These retrospective findings suggest low intraoperative blood product utilization and low thromboembolism rates following 4F-PCC use in pediatric cardiac surgery. Prospective studies would further establish dosing, safety and efficacy.