Efficacy and Safety of Prothrombin Complex Concentrates in Liver Transplantation: Evidence from Observational Studies.
Giovanni PunzoValeria Di FrancoValter PerilliTeresa SaccoLiliana SollazziPaola AcetoPublished in: Journal of clinical medicine (2023)
The risk/benefit ratio of using prothrombin complex concentrates (PCCs) to correct coagulation defects in patients with end-stage liver disease is still unclear. The primary aim of this review was to assess the clinical effectiveness of PCCs in reducing transfusion requirements in patients undergoing liver transplantation (LT). This systematic review of non-randomized clinical trials was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was previously registered (PROSPERO:CRD42022357627). The primary outcome was the mean number of transfused units for each blood product, including red blood cells (RBCs), fresh frozen plasma, platelets, and cryoprecipitate. Secondary outcomes included the incidence of arterial thrombosis, acute kidney injury, and haemodialysis, and hospital and intensive care unit length of stay. There were 638 patients from 4 studies considered for meta-analysis. PCC use did not affect blood product transfusions. Sensitivity analysis, including only four-factor PCC, showed a significant reduction of RBC effect size (MD: 2.06; 95%CI: 1.27-2.84) with no true heterogeneity. No significant differences in secondary outcomes were detected. Preliminary evidence indicated a lack of PCC efficacy in reducing blood product transfusions during LT, but further investigation is needed. In particular, future studies should be tailored to establish if LT patients will likely benefit from four-factor PCC therapy.
Keyphrases
- systematic review
- meta analyses
- end stage renal disease
- intensive care unit
- red blood cell
- acute kidney injury
- randomized controlled trial
- peritoneal dialysis
- patients undergoing
- ejection fraction
- newly diagnosed
- cardiac surgery
- patient reported outcomes
- mesenchymal stem cells
- clinical trial
- case control
- pulmonary embolism
- adverse drug
- insulin resistance
- mechanical ventilation
- smoking cessation