Finding the best treatment for stopping major bleeds after heart surgery

A pragmatic pilot randomised control trial of Prothrombin complex concentrates versus fresh frozen plasma in adult patients who are undergoing heart surgery (PROPHESY)

During heart surgery, about one in five patients are at risk of experiencing a major bleed which requires a blood transfusion. During bleeds, doctors often give these patients a product called fresh-frozen-plasma (FFP), which is made up of blood from which the red blood cells have been removed. FFP contains factors which promote clots and help to stop and prevent bleeding. But giving patients this treatment is not without risks. Sometimes transfusions can cause allergic reactions or anaphylactic shock, fluid overload or infections. Some doctors prefer to use a new treatment called prothrombin-complex-concentrate (PCC). This treatment is a more concentrated mixture of several clotting factors and has the potential to stop bleeding faster. It can also be given in smaller volumes, which prevents overloading patients with fluids. Until now, there have been no studies that directly compare the two treatments. Dr Laura Green from Queen Mary, University of London is leading a pilot study, to address this question in a small number of patients. If the results of this trial are promising, it could lead to a larger trial to determine which treatment is better at preventing deaths from major bleeds and with limited side effects. These results could ultimately help refine the protocols used in surgery to help save lives.