Comparison of fresh frozen plasma and prothrombin complex concentrate for the reversal of oral anticoagulants in patients undergoing cardiopulmonary bypass surgery: a randomized study
Comparison of fresh frozen plasma and prothrombin complex concentrate for the reversal of oral anticoagulants in patients undergoing cardiopulmonary bypass surgery: a randomized study
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DOI：
10.1111/j.1423-0410.2010.01339.x
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发表时间：
2010-01-01
期刊：
影响因子：
2.7
通讯作者：
Strengers, P. F. W.
中科院分区：
文献类型：
--
作者：
Demeyere, R.;Gillardin, S.;Strengers, P. F. W.
新鲜冷冻血浆（FFP）和凝血酶原复合物浓缩物（PCC）逆转口服抗凝剂。我们比较了PCC和FFP术中管理的患者接受心脏手术与心肺转流（CPB）MethodsForty例[国际标准化比率（INR）>= 2中心点1]分配半紧急心脏手术随机接受FFP（n = 20）或PCC（n = 20）。在CPB之前，他们接受2个单位的FFP或根据体重、初始INR和目标INR计算的PCC剂量的一半（<1个中心点5）。CPB和鱼精蛋白给药后，患者接受另外2个单位的FFP或另一半PCC剂量。结果CPB后15分钟，PCC患者达到INR目标的人数增加（P = 0中心点00 7）：7/16例患者vs. 0/15例FFP患者; CPB后1 h，两组患者INR指标无差异（6/15例PCC患者vs. 4/15例FFP患者达到INR目标）。CPB后15分钟，中位INR（范围）降至1个中心点6（1个中心点2 - 2个中心点2）PCC与2个中心点3（1个中心点5 - 3个中心点5），具有FFP; CPB后1小时，两组均达到相似值[1个中心点6（1个中心点3 - 2个中心点2）和1个中心点7（1个中心点3 - 2个中心点7）]。PCC组需要额外剂量的患者（6/20）少于FFP组（20/20）（P <0，中心点0.01）。随着时间的推移，两组在因子II（P = 0中心点0023）和因子X（P = 0中心点008）的过程中存在显著差异。在CPB开始时凝血因子的稀释度最大。两组的安全性都很好，只有两个相关的渗血的情况下，FFP.ConclusionPCC逆转抗凝安全，更快，出血少，比FFP。
BackgroundFresh frozen plasma (FFP) and prothrombin complex concentrates (PCC) reverse oral anticoagulants. We compared PCC and FFP intraoperative administration in patients undergoing heart surgery with cardiopulmonary bypass (CPB).MethodsForty patients [with international normalized ratio (INR) >= 2 center dot 1] assigned semi-urgent cardiac surgery were randomized to receive either FFP (n = 20) or PCC (n = 20). Prior to CPB, they received either 2 units of FFP or half of the PCC dose calculated according to body weight, initial INR and target INR (< 1 center dot 5). After CPB and protamine administration, patients received either another 2 units of FFP or the other half PCC dose. Additional doses were administered if INR was still too high (>= 1 center dot 5).ResultsFifteen minutes after CPB, more patients reached INR target with PCC (P = 0 center dot 007): 7/16 patients vs. 0/15 patients with FFP; there was no difference 1 h after CPB (6/15 patients with PCC vs. 4/15 patients with FFP reached target). Fifteen minutes after CPB, median INR (range) decreased to 1 center dot 6 (1 center dot 2-2 center dot 2) with PCC vs. 2 center dot 3 (1 center dot 5-3 center dot 5) with FFP; 1 h after CPB both groups reached similar values [1 center dot 6 (1 center dot 3-2 center dot 2) with PCC and 1 center dot 7 (1 center dot 3-2 center dot 7) with FFP]. With PCC, less patients needed additional dose (6/20) than with FFP (20/20) (P < 0 center dot 001). Both groups differed significantly on the course of factor II (P = 0 center dot 0023) and factor X (P = 0 center dot 008) over time. Dilution of coagulation factors was maximal at CPB onset. Safety was good for both groups, with only two related oozing cases with FFP.ConclusionPCC reverses anticoagulation safely, faster and with less bleeding than FFP.