• David Faraoni, Anna Guindi, Ashish A Ankola, Ashraf Resheidat, Ziyad Binsalamah, Jun Teruya, Fabio Savorgnan, and David F Vener.
• Arthur S. Keats Division of Pediatric Cardiovascular Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. Electronic address: dxfaraon@texaschildrens.org.
• J. Cardiothorac. Vasc. Anesth. 2024 Feb 1; 38 (2): 388393388-393.

ObjectivesTo compare the incidences of postoperative thrombotic complications, transfusion of blood products, and chest tube output in congenital cardiac surgical patients who received either recombinant activated factor VII (rFVIIa) or 4-factor prothrombin complex concentrate (4F-PCC).DesignWe performed a retrospective study.SettingPatients who underwent surgery at a tertiary academic hospital.ParticipantsPediatric patients who underwent cardiac surgery.InterventionsNone.Measurements And Main ResultsData were obtained from the Society of Thoracic Surgeons and the Pediatric Cardiac Critical Care Consortium databases, as well as from manual chart review. Adjusted p values were obtained from multivariate regression using age (days), surgeon (number), cardiopulmonary bypass time (minutes), and need for deep hypothermic circulatory arrest (yes/no). A total of 55 patients were included in the 4F-PCC group, and 89 in the rFVIIa group. The median dose of rFVIIa was 77 mcg/kg (46-88), and the median dose of 4F-PCC was 31 IU/kg (24-43). The incidences of thrombotic complications were 8% in the 4F-PCC group and 30% in the rFVIIa group (adjusted p = 0.023). No difference was reported between the groups regarding chest tube output on days 1 and 2 or transfusion of blood products. Using a sensitivity analysis with propensity matching, the incidence of thrombosis was 10% in the 4F-PCC group (n = 38), and 31% in the rFVIIa group (n = 39) (p = 0.036). No difference was reported in terms of bleeding or transfusion.ConclusionsThis retrospective study suggested that the administration of rFVIIa was associated with a higher risk of thrombotic complications when compared to 4F-PCC, without benefits in terms of bleeding and transfusions.Copyright © 2023 Elsevier Inc. All rights reserved.

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