Why the study?
Does the combination of 4-factor PCC and FFP resolve cardiac surgical bleeding in a patient with severe factor XI deficiency unresponsive to FFP alone?
Does the combination of 4-factor PCC and FFP resolve cardiac surgical bleeding in a patient with severe factor XI deficiency unresponsive to FFP alone?
The combination of 4-factor PCC and FFP may be an effective treatment for cardiac surgical bleeding in patients with severe factor XI deficiency who do not respond to FFP alone.
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Heightens perioperative bleeding caution for high-fibrinolytic surgeries in factor XI deficiency; leaves open optimal treatment selection.
Factor XI deficiency is associated with a bleeding tendency in some patients. Factor XI helps to reduce fibrinolysis. Bleeding risk is increased in factor XI-deficient patients during surgeries with high fibrinolytic activity, including nasopharyngeal/oropharyngeal and genitourinary surgeries. Treatment options for factor XI-deficient patients include fresh frozen plasma (FFP), antifibrinolytics, recombinant factor VIIa, and factor XI concentrates (available in Australia, Canada, and some European countries). 4-factor prothrombin complex concentrate (4-factor PCC) is an extract of FFP comprised of unactivated factors II, VII, IX, and X, proteins C and S, and heparin. It has been used for cardiac surgical bleeding. We report the first case of a patient with severe factor XI deficiency and cardiac surgical bleeding, which resolved with the combination of 4-factor PCC and FFP after lack of response to FFP alone.
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Boateng et al. (2023) studied this question.
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