A new international study has found that prothrombin complex concentrate (PCC) is not only safer but also more effective than frozen plasma in treating excessive bleeding caused by coagulation factor deficiency during cardiac surgery.
The unblinded, randomised trial included 420 adult patients across 12 hospitals in Canada and the United States. All participants had undergone cardiac surgery and experienced coagulopathic bleeding after cardiopulmonary bypass. Patients were randomly assigned to receive either PCC or frozen plasma to manage their bleeding.
The results revealed significantly higher haemostatic effectiveness in the PCC group, with 77.9% achieving effective bleeding control compared to 60.4% in the frozen plasma group. PCC also led to fewer transfusions of red blood cells, platelets, and plasma (mean 6.6 units vs 9.3 units).
Crucially, PCC was linked to fewer serious adverse events (36.2% vs 47.3%) and a lower rate of acute kidney injury (10.3% vs 18.8%). These safety findings mark a key advantage, particularly in a high-risk surgical setting.
The study, conducted between November 2022 and June 2024, suggests that PCC may be a superior alternative to frozen plasma for managing bleeding during cardiac surgery. Lead researchers noted the results could prompt a shift in standard care practices for surgical patients at risk of coagulopathic bleeding.
With its higher efficacy and improved safety profile, PCC may soon replace frozen plasma as the preferred option for coagulation factor replacement in cardiac operating theatres.
Reference
Karkouti K et al. Prothrombin complex concentrate vs frozen plasma for coagulopathic bleeding in cardiac surgery: The FARES-II multicenter randomized clinical trial. JAMA. 2025; doi:10.1001/jama.2025.3501.
