The off-label utilization of prothrombin complex concentrate with cryoprecipitate as an alternative to plasma transfusion in bleeding patients with acute right ventricular failure

摘要

To the Editor,The coagulopathic patient with right ventricular failure presents a conundrum to the perioperative clinician. Because these patients are preload dependent, hemorrhage may rapidly result in cardiogenic shock and end-organ ischemia. Acute coagulation factor replacement to correct factor deficiencies and reverse bleeding entails the transfusion of a large volume of plasma (10-15 rnL-kg~(-1)), which will increase most coagulation factors by 20-30% so as to approach the 30-40% target levels considered adequate for hemostasis.1 In turn, however, such large transfusion volumes can potentially decrease left ventricular preload and cardiac output through ventricular interdependence. Furthermore, when the surgical setting is cardiothoracic, volume overload may promote catastrophic wound or graft dehiscence. When confronted with such complex coagulopathic patients, we have administered the combination of prothrombin complex concentrates (PCCs) with cryoprecipitate as a lower-volume alternative to plasma transfusion.