cryoprecipitate vs prothrombin complex concentrate

17. Asian J Transfus Sci. 91, No. [3] The largest randomized multicenter clinical trial of fibrinogen concentrate, the FIBrinogen REplenishment in Surgery (FIBRES) study, enrolled 725 patients at 11 centers in Canada (Table 2).24 This study included adult patients who had significant bleeding related to acquired hypofibrinogenemia after CPB, defined as fibrinogen <200 mg/dL by the Clauss method or the fibrin-based thromboelastometry test extrinsically activated with tissue factor and containing the platelet inhibitor cytochalasin D (FIBTEM) amplitude <10 mm at 10 minutes. hb`````> [ l@}Fr;u`yZSy7h^ZhT)#,,6d3XdmY&x]lFZw:g@!_G sMb3b*j?9ClK4w4\@R)@E=`` %XA9H`gx*reJ,33+(30(1(/sgbbb>C!!!e*w+'18*tp a0 _l 2018; 16:21502158. One donor positive platelet unit was pathogen reduced and transfused 3 days after donation to a patient who remained asymptomatic, and a red blood cell (RBC) unit was given to a SARS-CoV-2positive patient. 196 0 obj <>stream It remains unclear whether fibrinogen concentrate will have equal efficacy in these types of cases where CPB duration is 200300 minutes.24, Fibrinogen concentrate is very costly in the United States. Individualized dosing is based on the severity of the disorder, extent and location of bleeding, and clinical status of the patient. Methods In anaesthetized mildly hypothermic pigs, 65-70% of total blood volume was substituted in phases with hydroxyethyl starch and red cells. Prothrombinex-VF LITFL CCC Pharmacology 24. This type of interprofessional team coordination can result in more effective therapy when using PCC when indicated, producing improved outcomes. The acquisition time for cryoprecipitate (3040 minutes) is considerably longer compared to fibrinogen concentrate because of the need to thaw cryoprecipitate. 0000001280 00000 n Even though allogeneic blood products have been screened since 1985 with nucleic acid testing for viruses such as hepatitis C and human immunodeficiency virus (HIV), it is impractical to screen for all viruses or emerging infectious diseases. 2015; 6:1935019351. Ten to 15% of the United States blood supply is transfused in cardiac surgical patients.1 Multiple factors including fibrinogen concentration impact bleeding and transfusion risk in cardiac surgical patients.24 About 15 years ago, most European countries removed cryoprecipitate from their markets and began to use fibrinogen concentrate for the treatment of acquired hypofibrinogenemia, mainly because of its superior safety profile. Callum J, Farkouh ME, Scales DC, et al. In a review of 14 individual studies of the reversal of warfarin anticoagulation, there were five thrombotic events in 308 patients who received 4-factor prothrombin complex concentrates and two in 161 patients who were given 3-factor prothrombin complex concentrates, although none of the adverse events was deemed clinically significant [11].The risk is therefore low, but it ought to be . Prothrombin Complex Concentrate Four factor PCC (Kcentra) is dosed on the amount of factor IX. Icheva V, Nowak-Machen M, Budde U, et al. Eguale T, Buckeridge DL, Verma A, et al. Ann Thorac Surg. Fibrinogen concentrate in cardiovascular surgery: a meta-analysis of randomized controlled trials. 49. 1. acquired deficiency of prothrombin complex coagulation factors when rapid correction of the deficiency is required 2. congenital deficiency of any of the vitamin K dependant coagulation factors when purified specific coagulation factors are unavailable Prothromplex T Not licensed for use in UK but may be made available on named patient basis. This observation led to the use of cryoprecipitate for treating the patients with hemophilia A and von Willebrand disease (VWD). 27. The 2 fibrinogen concentrates approved for the treatment of congenital hypofibrinogenemia in the United States are RiaSTAP (CSL Behring, King of Prussia, PA), which has a fibrinogen concentration of 9001300 mg/vial (~1000 mg); and FIBRYGA (Octapharma USA, Paramus, NJ), which has a fibrinogen concentration of 1000 mg/vial.21,22 Previous studies have demonstrated a significant variation in the fibrinogen content of cryoprecipitate, which ranges from 120 to 796 mg per individual unit.2326 This variability may lead to an inconsistent hemostatic efficacy for cryoprecipitate. Epub 2023 Mar 15. Franchini M, Lippi G. Fibrinogen replacement therapy: a critical review of the literature. 169 0 obj <> endobj Retrospective study of rFVIIa, 4-factor PCC, and a rFVIIa and 3-factor PCC combination in improving bleeding outcomes in the warfarin and non-warfarin patient. Both 4-factor PCC and rFVIIa appear to be safe and effective options for the management of bleeding associated with cardiac surgery. endobj The approximate dosing required described below should achieve the normalization of INR (less than or equal to 1.2) within 1 hour of treatment. 2009; 102:785792. 2. 2012; 18:833835. However, 48 patients in the fibrinogen concentrate group were nonadherent to the transfusion algorithm, which may have confounded the studys results. 2016 Nov [PubMed PMID: 27726162], Kopko PM,Bux J,Toy P, Antibodies associated with TRALI: differences in clinical relevance. Prothrombin Complex Concentrate Article - StatPearls In 1 group (n = 5), patients were treated with a transfusion algorithm based on the platelet count at cross-clamp removal and bleeding (defined by >60 g of blood weighed on surgical swabs), and in the other group (n = 10), patients were given fibrinogen concentrate before being transfused according to an algorithm. Prothrombin complex concentrate offers several advantages over FFP, most importantly, the small volume needed to reverse anticoagulation. Journal of the American College of Cardiology. In cases with long CPB duration, particularly in complex congenital heart surgery, acquired von Willebrand syndrome (VWS) is common, and cryoprecipitate may be a superior option for replacing both fibrinogen and large VWF multimers.51 Finally, patients on extracorporeal membrane oxygenation (ECMO) and patients with ventricular assist devices (VADs) are well known to have acquired VWS and may benefit from the treatment with cryoprecipitate compared to fibrinogen concentrate.5254. The objective of this retrospective study is to assess the hemostatic effectiveness of 4-factor PCC or rFVIIa for bleeding after a broad range of cardiac surgeries. 53. PCC vs. FFP for Post Cardiopulmonary Bypass Coagulopathy and Bleeding 2019; 23:98. The following formula can be used to find the dose fibrinogen concentrate. 0000014998 00000 n 0000014338 00000 n 0000009440 00000 n Alternatively, fibrinogen content is stable up to 5 weeks.14. and transmitted securely. Kozek-Langenecker S, Srensen B, Hess JR, Spahn DR. Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review. 0000049748 00000 n 0000049848 00000 n [Level 5], Hellstern P, Production and composition of prothrombin complex concentrates: correlation between composition and therapeutic efficiency. Cryoprecipitate also contains factor XIII, von Willebrand factor (vWF), and factor VIII; however, it is not used to replace these factors because factor concentrates and recombinant products with better . Pool JG, Gershgold EJ, Pappenhagen AR. 0000013134 00000 n PDF Anticoagulation Reversal Handout - EMCrit Project X@YQLw`J]$aTCPZ-S]T&-m_KX]cIbX^}>u~krM.UleEw 48. Octapharma; Accessed November 28, 2020. Fibronectin is the least appreciated factor in cryoprecipitate and only recently has its role in hemostasis been elucidated. Furthermore, evidence supporting the routine or prophylactic use of fibrinogen concentrate in the cardiac surgical patients is not robust, and larger studies are needed to confirm its value compared to cryoprecipitate, which has been the gold standard for treating acquired hypofibrinogenemia for almost 50 years. Accessibility [/CalRGB<>] Epub 2018 Jan 13. Coagulopathy During Cardiac Surgery: The Role of Factor Concentrates [2] It is used to treat and prevent bleeding in hemophilia B if pure factor IX is not available. 5J^REMTzP(s7l\wK g 0000006800 00000 n Activated Prothrombin Complex - an overview | ScienceDirect Topics Fibrinogen concentrates higher cost and lack of regulatory approval for treating acquired hypofibrinogenemia continue to be significant impediments to more widespread use in the United States despite widespread use in Canada and Europe. Comparison of Prothrombin Complex Concentrate with Activated Factor VII Use for Bleeding Following Cardiopulmonary Bypass in Children. The 3-factor-PCC contains factors II, IX, X, and little or no factor VII. Accessed January 21, 2021. Administration of Prothrombin Complex Concentrate vs. Standard 2016; 127:31333141. PCC contains significantly higher amounts of the clotting factors compared to FFP; one dose of PCC equals 8 to 16 units of FFP. xref <> 59. CFR-Code of Federal Regulations Title 21. . Vox Sang. In this study, the authors identified 28 possible cases of thromboembolism in >600,000 administered doses of fibrinogen concentrate. Cho J, Mosher DF. endobj A novel coronavirus from patients with pneumonia in China, 2019. 2020; 56:1825. stream 30. A prospective randomised pilot study. Cryoprecipitate therapy. Address e-mail to [emailprotected]. Randomized patients received 4 g of fibrinogen concentrate or 10 units of cryoprecipitate. Whether to use fibrinogen concentrate or cryoprecipitate as a first-line therapy for the treatment of acquired hypofibrinogenemia in the cardiac surgical patients continues to be a subject of intense debate in the United States. 2011; 91:944982. Activated Factor 7 Versus 4-Factor Prothrombin Complex Concentrate for Critical Bleeding Post-Cardiac Surgery. 39. 54. Antibodies associated with causingtransfusion-related acute lung injury (TRALI,defined as newacute lung injury that developed during or within 6 hours of transfusion of one or more units, not attributable to another ALI risk factor) - a significant cause of death after transfusion) are removed from PCC during the manufacturing process; therefore, PCC is associated with minimal risk compared to FFP. The FDA-approved indication is for urgent reversal of acquired coagulation factor deficiency induced by warfarin-induced anticoagulation in patients presenting with major acute bleeding (intracerebral hemorrhage-ICH) or needing urgent invasive surgery or procedure. sharing sensitive information, make sure youre on a federal 35 0 obj More recently, fibrinogen concentrate has been used off-label in the United States and is the standard in European countries and Canada to treat the acquired hypofibrinogenemia during cardiac surgery. / Khurrum, Muhammad; Ditillo, Michael; Obaid, Omar et al. The results demonstrate feasibility of utilizing the minimum amount of drug in order to achieve a desired effect. 2018 Feb;32(1):151-157. doi: 10.1053/j.jvca.2017.07.011. 0000000016 00000 n Tanaka KA, Egan K, Szlam F, et al. Bookshelf The FIBRES study reported a 2.6% higher thromboembolism rate in patients who received cryoprecipitate at 9.6% compared to 7.0% in patients who received fibrinogen concentrate (Table 1); however, this difference was not statistically different.24, Another randomized controlled trial, which included patients with pseudomyxoma peritonei and cytoreductive surgery, found a higher incidence of thromboembolic events in the cryoprecipitate group at 30.4% (7 of 23) compared to 0% (0 of 22) in the fibrinogen concentrate group.44 In a recent systematic review of randomized controlled trials examining fibrinogen concentrate, the authors concluded that the overall risk of thromboembolism is probably extremely low, and no studies reported a significantly increased risk of thromboembolism in patients receiving fibrinogen concentrate.20, Despite the findings of the FIBRES study, cryoprecipitate may be superior in some cardiac surgical patients.24 In the FIBRES study, the median CPB duration was 130140 minutes, but the CPB duration is often longer in complex aortic surgery with deep hypothermic circulatory arrest or in the other combined cardiac surgery procedures. <> J Clin Invest. Each vial has about 500 units of factor IX. Cryoprecipitate contains factor VIII, von Willebrand factor (VWF), fibrinogen, factor XIII, and fibronectin. 0000041416 00000 n 28. Roy A, Stanford S, Nunn S, et al. 18. 43. endobj 38 0 obj Full size image Patients in the FP group were slightly older, heavier, more likely to be male, and more likely to undergo non-elective surgery. endobj endobj Transfusion. J Crit Care. Safety of fibrinogen concentrate: analysis of more than 27 years of pharmacovigilance data. Listen to this Article of the Month podcast and more from OpenAnesthesia.org by visiting http://journals.lww.com/anesthesia-analgesia/pages/default.aspx. Get new journal Tables of Contents sent right to your email inbox, http://journals.lww.com/anesthesia-analgesia/pages/default.aspx, http://success.redcross.org/success/file.php/1/TransfusionPractices-Compendium_3rdEdition.pdf, https://www.fda.gov/media/105864/download, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=606.122, https://onlinelibrary.wiley.com/doi/10.1111/hae.14046, https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/updated-information-blood-establishments-regarding-covid-19-pandemic-and-blood-donation, Pro-Con Debate: Fibrinogen Concentrate or Cryoprecipitate for Treatment of Acquired Hypofibrinogenemia in Cardiac Surgical Patients, Articles in PubMed by Nadia B. Hensley, MD, Articles in Google Scholar by Nadia B. Hensley, MD, Other articles in this journal by Nadia B. Hensley, MD, Update on Applications and Limitations of Perioperative Tranexamic Acid, Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients, Blood Conservation and Hemostasis in Cardiac Surgery: A Survey of Practice Variation and Adoption of Evidence-Based Guidelines, Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular AnesthesiologistsPart II, Intraoperative Management and Troubleshooting, Red Blood Cell Transfusion and Postoperative Infection in Patients Having Coronary Artery Bypass Grafting Surgery: An Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database, Privacy Policy (Updated December 15, 2022), International Anesthesia Research Society, Standard concentration of ~1 g per vial, after reconstitution becomes 1 g per 50 mL, Variable concentration of ~120796 mg per 15 mL in each individual single donor unit, Nucleic acid testing for HIV, hepatitis A, B, and C, and human parvovirus in donor plasma units, Nucleic acid testing for HIV, hepatitis B and C, and other viruses, Additional viral inactivation through precipitation/adsorption/pasteurization processes, Fibrinogen and other coagulation factors including VWF, FVIII, FXIII, fibronectin, and platelet microparticles, Secondary hemostasis by increasing substrate for thrombin, Primary hemostasis by increasing VWF and platelet microparticles, Secondary hemostasis by increasing substrate for thrombin and FVIII activity (intrinsic tenase activity), Rapid reconstitution in minutes can be rapidly administered to the patient after reconstitution, Kept frozen at 20 C and requires 3045 min to thaw, once available can be rapidly administered to the patient, Shelf life after reconstitution or thawing, Shelf life is up to 24 h after reconstitution, Limited shelf life after thawing of 46 h; FVIII activity degrades relatively quickly, fibrinogen is more stable, Negligible risk of alloimmunization, TACO, TRALI, Low, but present risk of allergic transfusion reactions, alloimmunization, and other transfusion adverse events (TACO or TRALI), Acquisition cost of ~$1000 per 1 g in the United States, lower acquisition cost in Europe and Canada of ~$400$500 per 1 g, Acquisition cost of ~$300$400 per 56 unit pool in the United States, Additional hidden costs include blood bank processing (~45 min to 1 h) and wastage, which increase the total cost, No detectable adverse events; 1 vein graft occlusion in the FC group; LIMA grafts patient in both groups, Elective AVR and ascending aorta replacement, Postbypass with signs of clinical bleeding, Dose based on the MCF on FIBTEM; mean, 5.7 0.7 g, Transfusion of allogeneic blood products after CPB in 24 h postop, Significantly fewer RBC, FFP, and platelet transfusions in the FC group, Significantly lower chest tube output in the FC group, Elective valve replacement/repair, double valve, or valve + CABG, Hemostatic scores similar between groups; no differences in RBC, FFP, cryo transfusions between groups; less platelets in the FC group, Elective complex surgery with >90 min CPB and at least 1 risk factor, Dose based on MCF on FIBTEM for target = 22 mm, Avoidance of any allogeneic blood products up to 30 d postop. Prothrombincomplex concentrates (PCCs) are highly purified concentrates with haemostatic activity pre- paredfrom pooled plasma. endstream endobj 170 0 obj <>>> endobj 171 0 obj <. [6]To prevent the activation of these factors, PCC alsocontains heparin. 2016; 117:4151. 40 0 obj Hoffman M, Jenner P. Variability in the fibrinogen and von Willebrand factor content of cryoprecipitate. 2012; 114:261274. Solomon et als43 pharmacovigilance evaluation of fibrinogen concentrate over a 27-year period specifically analyzed the risk of thromboembolism. 47. . 2020; 18:352363. Frontiers | Prothrombin Complex Concentrate in Liver Transplant Surgery 61. Cryoprecipitate has been available for transfusion since 1964; initially as therapy for haemophilia A, then rapidly becoming first line treatment for von Willebrand's disease and heritable deficiencies of fibrinogen and FXIII 1.With the advent of single-factor concentrate therapy the number of clinical indications for cryoprecipitate has reduced. Unauthorized use of these marks is strictly prohibited. For several years, FFP and vitamin K were the preferred options for reversing anticoagulation. Disclaimer. 2017. 57. Anesth Analg. Abbreviations: AVR, aortic valve replacement; CABG, coronary artery bypass grafting; CI, confidence interval; CPB, cardiopulmonary bypass; cryo, cryoprecipitate; CT, computed tomography; FC, fibrinogen concentrate; FFP, fresh frozen plasma; FIBTEM, fibrin-based thromboelastometry test extrinsically activated with tissue factor and containing the platelet inhibitor cytochalasin D; IQR, interquartile range; LIMA, left internal mammary artery; MCF, maximum clot firmness; OR, odds ratio; postop, postoperative; prox, proximal; RBC, red blood cell; TAA, thoracic aortic aneurysm; TAAA, thoracoabdominal aneurysm. Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding. Low levels of factor XIII are associated with increased postoperative bleeding and reoperation for bleeding in the cardiac surgery.55 Factor XIII administration was previously found to reduce blood loss in the CABG patients, when given at a dose of 1250 or 2500 IU.56 Unfortunately, these results were not replicated in a larger study of cardiac surgical patients, where 17.5 and 35 IU/kg doses were administered, and there was no reduction in allogeneic transfusion or reoperation.57 Nevertheless, in patients with excessive hemodilution or in those with major blood loss, the additional factor XIII activity that is present in the cryoprecipitate may be beneficial in achieving hemostasis. 41 0 obj Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. Anesthesiology. <> [1] [3] It may also be used for reversal of warfarin therapy. Cryoprecipitate as a reliable source of fibrinogen replacement. 2009. This activity outlines the indications, mechanism of action, methods of administration, significant adverse effects, contraindications, monitoring, and toxicity of prothrombin complex concentrate, so providers can direct patient therapy in treating conditions for which it is indicated, as part of the interprofessional team. Plasma fibronectin supports hemostasis and regulates thrombosis. 3. PCC are . Fridey JL, ed. Prothrombin complex concentrate vs fresh frozen plasma for reversal of Randomized, double-blinded, placebo-controlled trial of fibrinogen concentrate supplementation after complex cardiac surgery. 36. Effects of hemodilution, blood loss, and consumption on hemostatic factor levels during cardiopulmonary bypass. Compared with fresh frozen plasma (FFP), prothrombin complex concentrate (PCC) may potentially offer a more rapid and effective means of normalizing coagulation factor levels. The two groups were then compared for: correction of INR, time to correction of INR, thromboembolic complications, mortality, and cost of therapy. Patients with aortic stenosis have loss of large VWF multimers due to high shear stress, which is referred to as Heyde syndrome.50 The Heyde syndrome is similar to type 2a VWD, where there is a loss of VWF function and poor platelet adhesion to collagen. 0000002270 00000 n Ferraris VA, Brown JR, Despotis GJ, et al. 33. Patients had to be normothermic, have an activated clotting time within 25% of their baseline value, and have a pH value of >7.3.41 The study found that there was a median of 5.0 (interquartile range [IQR], 2.011.0) units of allogeneic blood products administered in the fibrinogen concentrate group within 24 hours versus only 3.0 (IQR, 0.07.0) units in the placebo group (P = .026). FDA-approved fibrinogen concentrates contain a standardized concentration of fibrinogen (Table 1). In the Randomized Evaluation of Fibrinogen Versus Placebo in Complex Cardiovascular Surgery (REPLACE) trial, 152 patients undergoing elective aortic replacement surgery were randomized to receive either fibrinogen concentrate or placebo, depending on whether there was a bleeding mass of 60250 g on surgical packing post-CPB. A recent meta-analysis of randomized controlled trials of fibrinogen concentrate in the cardiac surgical patients suggested that the fibrinogen concentrate decreases RBC transfusion (relative risk [RR] = 0.64; 95% CI, 0.49-0.83), but there was no reduction in other transfusions (eg, platelets and plasma), and there was no reduction in the reoperations for bleeding.49 Taken together, the current evidence supporting the routine use of fibrinogen concentrate in the cardiac surgical patients is not particularly strong, even when the treatment is based on the whole blood viscoelastic coagulation testing. The authors found that 67.2% of patients in the treatment arm avoided any allogeneic transfusion (primary outcome) compared to 44.8% in the control group (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.19-0.84). History of DIC (disseminated intravascular coagulation), Angina, myocardial infarction, peripheral vascular disease, or stroke in the last three months, Thromboembolic disease event history in the previous three months, Known anaphylactic or severe systemic reactions to prothrombin complex concentrate,albumin hypersensitivity, heparin hypersensitivity, plasma protein hypersensitivity, Labor, obstetric delivery, pregnancy: PCC effect on the fetus is unknown - it is not recommended to use PCC in pregnant patients or during labor unless clearlyindicated and benefits outweigh the risk, Breastfeeding: It is unknown if PCC gets excreted in breast milk - it may be used only if benefits clearlyoutweigh the risks; suspend breastfeeding while receiving PCC, Hepatitis, infection: there is a risk of viral transmission as with all other blood products - although this risk is significantly lower in PCC compared to FFP, Patients with non-survivable acute injuries or illness, Prothrombin time (PT), activated partial thromboplastin time (PTT), fibrinogen, Signs and symptoms of thromboembolism during and after administration of PCC, Feel free to get in touch with us and send a message. 2008 Nov [PubMed PMID: 18946305], Josef AP,Garcia NM, Systemic Anticoagulation and Reversal. WFH Guidelines for the Management of Hemophilia. Name: Michael A. Mazzeffi, MD, MPH, MSc, FASA. Adam EH, Meier J, Klee B, et al. 169 28 Ranucci M, Baryshnikova E, Crapelli GB, Rahe-Meyer N, Menicanti L, Frigiola A; Surgical Clinical Outcome REsearch (SCORE) Group. endobj 55. 1964; 203:312. American Red Cross, Accessed November 27, 2020. Pharmacists can be an excellent resource in this setting, guiding clinicians concerning dosing and indications for administration and answering team members' questions about the medication. [11], Higher doses of PCC can increase the risk of thromboembolism. 0000011914 00000 n The association of prothrombin complex concentrates with postoperative Prothrombin complex concentrate (PCC) decreases INR faster than plasma in emergency situations and are the first choice of treatment, but plasma can be used if PCC is not available or if it is contraindicated. Thromboembolic complications at 30 days were similar between the two groups (4-factor PCC: 13% vs. rFVIIa 26%, p = 0.08). J Cardiothorac Vasc Anesth. Leach Bennett J, Blajchman MA, Delage G, Fearon M, Devine D. Proceedings of a consensus conference: risk-based decision making for blood safety. Kalbhenn J, Schlagenhauf A, Rosenfelder S, Schmutz A, Zieger B. No evidence of SARS-CoV-2 transfusion transmission despite RNA detection in blood donors showing symptoms after donation. <> 0000010713 00000 n Address correspondence to Nadia B. Hensley, MD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Ave, Zayed Tower 6212, Baltimore, MD 21287. 2011; 113:13191333. These findings met the prespecified criteria for noninferiority. 0000003751 00000 n CSL Behring; Accessed November 27, 2020. Role of fibronectin assembly in platelet thrombus formation. Cappy et al30 reported that between January 20 and May 29 of 2020, 311 blood donations to the French National Blood Service were investigated including 268 postdonation infections (PDIs) and 43 trace-back donations (patients who reported COVID-19 symptoms within 14 days of donation). We compared the standard dosage of FFP and PCC in terms of efficacy and safety for patients with mechanical heart valves undergoing interventional procedures while receiving Warfarin. Karkouti K, McCluskey SA, Syed S, Pazaratz C, Poonawala H, Crowther MA. Am J Clin Pathol. FFP versus Cryoprecipitate - UpToDate 2016; 111:292298. J Cardiothorac Vasc Anesth. Prothrombin complex concentrate in cardiac surgery for the treatment of coagulopathic bleeding. 2007 Jan [PubMed PMID: 17174219], Franchini M,Lippi G, Prothrombin complex concentrates: an update.
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