(446) Evaluation of Factor Concentrates for Persistent Bleeding Post-Cardiothoracic Surgery

Introduction: Cardiothoracic surgery poses a risk of persistent bleeding due to impaired coagulation, platelet dysfunction, and increased fibrinolysis, and as a result, increases morbidity and mortality. Factor concentrates, such as four-factor prothrombin complex concentrate (4F-PCC), and recombinant factor VIIa (rFVIIa), are utilized to decrease transfusions, chest tube output, and re-exploration. At Loyola University Medical Center, a protocol for persistent bleeding in cardiothoracic surgery patients was updated based on available evidence to fixed dose 4F-PCC and a decreased weight-based dose of rFVIIa. The purpose of this study was to evaluate the efficacy and safety of the pre- versus post-change, as well as compare outcomes to available literature since there is no standard of care.

Methods: This was a retrospective, single-centered, cohort study of patients who received factor concentrates for persistent bleeding post cardiothoracic surgery. The primary outcome was chest tube output at 24 hours. The secondary outcomes included fresh frozen plasma transfusions, re-exploration, ICU/hospital length of stay, 30-day mortality, and cost. The safety outcome was the rate of thrombotic events.

Results: Of the 439 patients that were given 4F-PCC, 198 patients met inclusion criteria. Baseline characteristics were similar between the two groups. The primary outcome of chest tube output within 24 hours was similar between the two groups (720 vs 700 mL, p=0.982). The secondary outcomes of re-exploration events, ICU/hospital length of stay, and 30-day mortality were similar between groups. Fresh frozen plasma transfusions were higher in the pre-change group compared to the post-change group (4 vs 2, p=0.000). Regarding safety outcomes, there were no differences in thrombotic events. The cost analysis showed, on average, $9,911.27 vs $6,405.82 was spent per person on factor use for pre- vs post-change group, respectively.

Conclusions: Patients in the post-change group had similar chest tube blood loss, red blood cell and platelet transfusions, re-exploration events as well as thrombotic events. This creates potential to utilize a fixed-dose based dosing regimen along with a decreased dose of rFVIIa for a cost benefit.