Three factor Prothrombin Complex Concentrate to Reverse Warfarin Treated Mechanical Circulatory Device Patients Immediately Prior to Heart Transplant

Abstract

Objectives: To determine if using three-factor prothrombin complex concentrate (PCC) immediately prior to heart transplantation reduces blood product transfusions in patients bridged to heart transplantation by mechanical circulatory support (MCS) devices who are treated with warfarin. Methods: This study retrospectively reviewed patients that either received PCC or received usual care (i.e. fresh frozen plasma – FFP) prior to heart transplantation. Outcomes that were evaluated included packed red blood cell (RBC), FFP, platelet and cryoprecipitate transfusions intra and five days post-operatively, Cell Saver autologous blood volume administered intra-operatively, chest tube output for the five days post-operatively, and thromboembolic events post-operatively. Results: There were 24 patients included in the study, 12 from each group. The PCC group showed significantly less intra-operative RBC transfusion (2.60 ± 1.49 units vs. 5.09 ± 2.42 units, p=0.018), Cell Saver autologous blood usage (2.60 ± 1.49 units vs. 4.02 ± 1.55 units, p=0.032), and FFP transfusion (2.14 ± 2.30 units vs. 10.94 ± 5.96 units, p=0.0005) than the usual care group. There was no difference in amount of vitamin K given, change in INR, platelets administered, cryoprecipitate administered, chest tube output, or thromboembolic events between the groups. The average dose of PCC was 31 units/kg IV; repeat doses were given to 2 patients. Conclusions: We propose that the use of PCC prior to heart transplant surgery for patients on MCS devices anticoagulated with warfarin may result in the reduction for the need of RBC’s, autologous blood use and FFP during surgery.