• Michael Mazzeffi, Jared Beller, Raymond Strobel, Anthony Norman, Alexander Wisniewski, Judy Smith, Clifford E Fonner, John McNeil, Alan Speir, Ramesh Singh, Daniel Tang, Mohammed Quader, Leora Yarboro, and Nicholas Teman.
• University of Virginia, Department of Anesthesiology, Charlottesville, VA. Electronic address: mmazzeff@uvahealth.org.
• J. Cardiothorac. Vasc. Anesth. 2024 Mar 1; 38 (3): 660666660-666.

ObjectivesTo explore trends in intraoperative procoagulant factor concentrate use in patients undergoing heart transplantation (HTx) in Virginia. Secondarily, to evaluate their association with postoperative thrombosis.DesignPatients who underwent HTx were identified using a statewide database. Trends in off-label recombinant activated factor VII (rFVIIa) use and on-label and off-label prothrombin complex concentrate (PCC) use were tested using the Mantel-Haenszel test. Multivariate logistic regression was used to test for an association between procoagulant factor concentrate administration and thrombosis.SettingVirginia hospitals performing HTx.ParticipantsAdults undergoing HTx between 2012 and 2022.InterventionsNone.Measurements And Main ResultsAmong 899 patients who required HTx, 100 (11.1%) received off-label rFVIIa, 69 (7.7%) received on-label PCC, and 80 (8.9%) received off-label PCC. There was a downward trend in the use of rFVIIa over the 10-year period (p = 0.04). There was no trend in on-label PCC use (p = 0.12); however, there was an increase in off-label PCC use (p < 0.001). Patients who received rFVIIa were transfused more and had longer cardiopulmonary bypass time (p < 0.001). Receipt of rFVIIa was associated with increased thrombotic risk (odds ratio [OR] 1.92; 95% CI 1.12-3.29; p = 0.02), whereas on-label and off-label PCC use had no association with thrombosis (OR 0.98, 95% CI 0.49-1.96, p = 0.96 for on-label use; and OR 0.61, 95% CI 0.29-1.30, p = 0.20 for off-label use).ConclusionsUse of rFVIIa in HTx decreased over the past decade, whereas off-label PCC use increased. Receipt of rFVIIa was associated with thrombosis; however, patients who received rFVIIa were more severely ill, and risk adjustment may have been incomplete.Copyright © 2023. Published by Elsevier Inc.

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