Evidence map›Paper›PMID 30937927›Full record

ArticleVox sanguinis2019

Three-factor prothrombin complex concentrates for refractory bleeding after cardiovascular surgery within an algorithmic approach to haemostasis.

Nazish K Hashmi, Kamrouz Ghadimi, Amudan J Srinivasan, Yi-Ju Li, Robert D Raiff, Jeffrey G Gaca, Adam G Root, Yaron D Barac, Thomas L Ortel, Jerrold H Levy and 1 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Vox sanguinis, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
1.4field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 20 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

Nazish K HashmiDepartment of Anesthesiology & Critical Care, Divisions of Cardiothoracic Anaesthesia & Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA.
Kamrouz GhadimiDepartment of Anesthesiology & Critical Care, Divisions of Cardiothoracic Anaesthesia & Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA.ORCID https://orcid.org/0000-0002-9287-7541
Amudan J SrinivasanDepartment of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.ORCID https://orcid.org/0000-0002-9324-4228
Yi-Ju LiDepartment of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
Robert D RaiffCenter for Medication Policy, Department of Pharmacy, Duke University Hospital Durham, NC, USA.
Jeffrey G GacaDepartment of Surgery, Division of Cardiothoracic Surgery, Duke University School of Medicine, Durham, NC, USA.
Adam G RootCenter for Medication Policy, Department of Pharmacy, Duke University Hospital Durham, NC, USA.
Yaron D BaracDepartment of Surgery, Division of Cardiothoracic Surgery, Duke University School of Medicine, Durham, NC, USA.
Thomas L OrtelDepartments of Pathology, Hematology, and Medicine, Duke University School of Medicine, Durham, NC, USA.
Jerrold H LevyDepartment of Anesthesiology & Critical Care, Divisions of Cardiothoracic Anaesthesia & Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA.ORCID https://orcid.org/0000-0003-3766-4962
Ian J WelsbyDepartment of Anesthesiology & Critical Care, Divisions of Cardiothoracic Anaesthesia & Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA.
Duke University · USDuke University Hospital · USUniversity of Pittsburgh · US

Funding

INTEGRATED TRAINING IN ANESTHESIOLOGY RESEARCHT32GM008600 · NIGMS · DUKE UNIVERSITY · PI Miriam Treggiari · 1996 to 2026
$6.6M
Point-of-Care RBC Washing to Prevent Transfusion-Related Pulmonary ComplicationsR01HL121232 · NHLBI · MAYO CLINIC ROCHESTER · PI KOR, DARYL J, WELSBY, IAN J · 2014 to 2018
$3.2M
National Heart, Lung, and Blood Institute R01HL121232-01National Institute of General Medical Sciences 5T32GM00860NHLBI NIH HHS R01 HL121232NIGMS NIH HHS T32 GM008600
6 · The paper itself

Abstract

BACKGROUND/

objectivesProthrombin complex concentrates (PCC) are increasingly administered off-label in the United States to treat bleeding in cardiovascular surgical patients and carry the potential risk for acquired thromboembolic side-effects after surgery. Therefore, we hypothesized that the use of low-dose 3-factor (3F) PCC (20-30 IU/kg), as part of a transfusion algorithm, reduces bleeding without increasing postoperative thrombotic/thromboembolic complications. MATERIALS/

methodsAfter IRB approval, we retrospectively analysed 114 consecutive, complex cardiovascular surgical patients (age > 18 years), between February 2014 and June 2015, that received low-dose 3F-PCC (Profilnine

resultsTotal allogeneic blood product transfusion reached a mean of 12·4 ± 9·9 units before PCC and 5·0 ± 6·3 units after PCC administration (P < 0·001). The mean PCC dose was 15·8 ± 7·1 IU/kg. Four patients (3·8%) each experienced an ischaemic stroke on postoperative day 1, 2, 4 and 27. Seven patients (6·5%) had acquired venous thromboembolic disease within 10 days of surgery. Median factor II level after transfusion algorithm adherence and PCC administration was 87%.

conclusions3F-PCC use for refractory bleeding after cardiovascular surgery resulted in reduced transfusion of allogeneic blood and blood products. Adherence to this algorithmic approach was associated with an acceptable incidence of postoperative thrombotic/thromboembolic complications.

Indexed as

Blood CoagulationHemostasisAdolescentAdultAgedAged, 80 and overAlgorithmsBlood Coagulation FactorsBlood Coagulation TestsBlood PlateletsBlood TransfusionCardiopulmonary BypassFemaleFibrinogenHemorrhageHumansBlood Coagulation FactorsFibrinogenprothrombin complex concentratesblood componentscoagulation factor concentratequality controlquality managementrecombinant proteinstransfusion - surgery

Identifiers

PMID30937927
PMCPMC6525021
OpenAlexW2929305885

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.