Is It Time to Replace Plasma With Prothrombin Complex Concentrate in Cardiac Surgery?

Bleeding after cardiac surgery with cardiopulmonary bypass is associated with adverse clinical outcomes and increased resource utilization. Broadly speaking, this bleeding can be due to inadequate surgical hemostasis or microvascular bleeding caused by bypass-induced platelet dysfunction and/or depletion of coagulation factors. The most common method of restoring coagulation factors in this setting is through the transfusion of thawed frozen plasma, which occurs in approximately 25% of cardiac surgeries. Plasma is generally regarded as a safe treatment, with very low rates of transfusion-related acute lung injury (<0.01%) and severe allergic reactions (<0.01%). The most common adverse event in this setting is transfusion-associated circulatory overload (<0.1%). The rapid administration of the amount of plasma needed to treat coagulopathy (750-1000 mL of thawed frozen plasma) can be particularly detrimental in some patients, including those with significant right ventricular dysfunction or those who are euvolemic.