• Endre Nemeth, Tamas Varga, Adam Soltesz, Kristof Racz, Gergely Csikos, Viktor Berzsenyi, Eszter Tamaska, Zsolt Lang, Gabriella Molnar, Kalman Benke, Ajandek Eory, Bela Merkely, and Janos Gal.
• Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary. Electronic address: nemeth.endre@med.semmelweis-univ.hu.
• J. Cardiothorac. Vasc. Anesth. 2022 Jan 1; 36 (1): 138-146.

ObjectiveThe goal of this study was to compare factor concentrate (FC)-based and blood product-based hemostasis management of coagulopathy in cardiac surgical patients in terms of postoperative bleeding, required blood products, and outcome.DesignRetrospective, propensity score-matched analysis.SettingSingle, tertiary, academic medical center.ParticipantsOne hundred eighteen matched pairs of 433 consecutive patients scheduled for cardiac surgery in two isolated periods with distinct strategies of hemostasis management.InterventionsPatients received either blood product-based (period I) or FC-based (period II) hemostasis management to treat perioperative coagulopathy.Measurements And Main ResultsPatients treated with FC management experienced less postoperative blood loss (907 v 1,153 mL, p = 0.014) and required less red blood cell and fresh frozen plasma transfusion (2.3 v 3.7 units p < 0.0001, and 2.0 v 3.4 units p < 0.0001, respectively) compared with subjects in the blood product-based management group. The frequency of Stage 3 acute kidney injury and 30-day mortality rate were significantly higher in the blood product-based group than in the FC management group (6.8% v 0.8%, p = 0.016, and 7.2% v 0.8%, p = 0.022, respectively). FC management-related thromboembolic events were not registered. The FC strategy was associated with a 2.19-fold decrease in the odds of massive postoperative bleeding (p < 0.0001), a 2.56-fold decrease in the odds of polytransfusion (p < 0.0001), and a 13.16-fold decrease in the odds of early postoperative death (p = 0.003).ConclusionsFC-based versus blood product-based management is associated with reduced blood product needs and fewer complications, and was not linked to a higher frequency of thromboembolic events or a decrease in long-term survival in cardiac surgical patients developing perioperative coagulopathy and bleeding.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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