Abstract：
OBJECTIVE: To 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.
METHODS: A retrospective, propensity-matched study.
METHODS: A single, tertiary hospital.
METHODS: Patients who underwent noncoronary cardiac surgery with cardiopulmonary bypass between 2015 and 2023.
METHODS: None.
RESULTS: We 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.
CONCLUSIONS: In 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.
METHODS: A retrospective, propensity-matched study.
METHODS: A single, tertiary hospital.
METHODS: Patients who underwent noncoronary cardiac surgery with cardiopulmonary bypass between 2015 and 2023.
METHODS: None.
RESULTS: We 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.
CONCLUSIONS: In 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.
摘要：
目的：比较第八因子抑制剂旁路活性（FEIBA）与新鲜冰冻血浆（FFP）作为心脏手术患者术后凝血病的主要治疗方法的结果。
方法：回顾性研究，倾向匹配研究。
方法：单，三级医院。
方法：在2015年至2023年间接受体外循环非冠状动脉心脏手术的患者。
方法：无。
结果：我们根据患者是否接受了术中FFP或FEIBA将患者分为2组；同时使用FFP或FEIBA的病例被排除。我们分析了434例，197个接收FFP，237个接收FEIBA。在倾向匹配之后，需要打包红细胞输血的患者比例无显著差异(p=0.08).然而,那些需要打包红细胞输血的人，FEIBA组患者需要的红细胞体积明显减少(p<0.001).FEIBA组需要输注血小板(p<0.001)和冷沉淀(p<0.001)的患者明显较少。FEIBA组术后插管时间减少(p=0.05),重症监护病房住院时间缩短(p=0.04)，30天再入院率较低（p=0.03）。两组之间的血栓并发症发生率没有差异。
结论：在体外循环后凝血病的初始治疗中，FEIBA可能比FFP更有效地降低血液产品输血和再入院率。需要进一步的研究来探索FEIBA作为该患者人群中一线药物的潜在常规用途。
方法：回顾性研究，倾向匹配研究。
方法：单，三级医院。
方法：在2015年至2023年间接受体外循环非冠状动脉心脏手术的患者。
方法：无。
结果：我们根据患者是否接受了术中FFP或FEIBA将患者分为2组；同时使用FFP或FEIBA的病例被排除。我们分析了434例，197个接收FFP，237个接收FEIBA。在倾向匹配之后，需要打包红细胞输血的患者比例无显著差异(p=0.08).然而,那些需要打包红细胞输血的人，FEIBA组患者需要的红细胞体积明显减少(p<0.001).FEIBA组需要输注血小板(p<0.001)和冷沉淀(p<0.001)的患者明显较少。FEIBA组术后插管时间减少(p=0.05),重症监护病房住院时间缩短(p=0.04)，30天再入院率较低（p=0.03）。两组之间的血栓并发症发生率没有差异。
结论：在体外循环后凝血病的初始治疗中，FEIBA可能比FFP更有效地降低血液产品输血和再入院率。需要进一步的研究来探索FEIBA作为该患者人群中一线药物的潜在常规用途。
