• Hyungjoo Kim, Frank Manetta, Alan Hartman, Xueqi Huang, and Pey-Jen Yu.
• Division of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell, New Hyde Park, NY.
• J. Cardiothorac. Vasc. Anesth. 2024 Sep 1; 38 (9): 187518811875-1881.

ObjectivesTo compare the outcomes of factor eight inhibitor bypassing activity (FEIBA) versus fresh frozen plasma (FFP) as the primary treatment for postoperative coagulopathy in patients undergoing cardiac surgery.DesignA retrospective, propensity-matched study.SettingA single, tertiary hospital.ParticipantsPatients who underwent noncoronary cardiac surgery with cardiopulmonary bypass between 2015 and 2023.InterventionsNone.Measurements And Main ResultsWe stratified patients into 2 groups based on whether they received intraoperative FFP or FEIBA; cases using both were excluded. We analyzed 434 cases, with 197 receiving FFP and 237 receiving FEIBA. After propensity matching, there was no significant difference in the proportion of the patients who required packed red blood cell transfusions (p = 0.08). However, of those who required packed red blood cell transfusions, patients in the FEIBA group required significantly fewer units of packed red blood cells (p < 0.001). Significantly fewer patients in the FEIBA group required platelet (p < 0.001) and cryoprecipitate (p < 0.001) transfusions. The FEIBA group showed decreased prolonged postoperative intubation (p = 0.05), decreased intensive care unit length of stay (p = 0.04), and lower 30-day readmission rates (p = 0.03). There were no differences in the rates of thrombotic complications between the 2 cohorts.ConclusionsIn the initial treatment of postcardiopulmonary bypass coagulopathy, FEIBA may be more effective than FFP in decreasing blood product transfusions and readmission rates. Further studies are needed to explore the potential routine use of FEIBA as first-line agent in this patient population.Copyright © 2024 Elsevier Inc. All rights reserved.

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