Comparison of fresh frozen plasma and prothrombin complex concentrate for the reversal of oral anticoagulants in patients undergoing cardiopulmonary bypass surgery: a randomized study

Background Fresh 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). Methods Forty 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). Results Fifteen 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. Conclusion PCC reverses anticoagulation safely, faster and with less bleeding than FFP.