# Effectiveness of Prothrombin Complex Concentrate Versus Fresh Frozen Plasma in Major Cardiac Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

## TL;DR

This study compares prothrombin complex concentrate and fresh frozen plasma in major cardiac surgeries, finding PCC more effective for blood clotting with similar safety.

## Contribution

A meta-analysis showing prothrombin complex concentrate (PCC) is more effective than fresh frozen plasma (FFP) in managing bleeding during major cardiac surgeries.

## Key findings

- PCC reduced INR more effectively than FFP (MD = -0.13).
- PCC led to less blood drained from chest tubes and fewer RBC transfusions.
- PCC showed higher hemostatic effectiveness rates (RR = 1.18).

## Abstract

Major bleeding is a common and important complication following major cardiac surgeries. Fresh frozen plasma (FFP) is the standard therapy for bleeding-related complications. Prothrombin complex concentrate (PCC) may offer a good alternative during cardiac surgeries. We aimed to assess whether PCC could potentially replace FFP in clinical practice. We searched different databases from inception until July 2025 for only randomized controlled trials (RCTs) that compared PCC with FFP in patients undergoing major cardiac surgeries and assessed our outcomes of interest in an intention-to-treat analysis. The primary outcome of interest was the change in international normalized ratio (INR). Data were pooled as risk ratio (RR) and mean difference (MD) with their 95% confidence intervals (CIs). A total of six RCTs with 761 patients were included in the final analysis. Patients allocated to PCC had lower INR values compared to those allocated to FFP (MD = -0.13, 95% CI: -0.18 to -0.07, p < 0.001). Additionally, PCC administration was associated with less blood drained from chest tubes (MD = -157.06 mL, 95% CI: -252.92 to -61.19, p < 0.001), fewer transfused RBC units (MD = -0.95, 95% CI: -1.25 to -0.65, p < 0.001), and higher hemostatic effectiveness rates (RR = 1.18, 95% CI: 1.02 to 1.36, p = 0.03). No significant differences were observed regarding safety measures. In patients undergoing major cardiac surgeries, the use of PCC showed superior effectiveness over FFP regarding hemostatic efficacy and other related outcomes. Also, PCC demonstrated similar safety measures compared to FFP.