Recent Exposure to Four-Factor Prothrombin Complex Concentrate (4F-PCC) is Associated with Intracardiac Thrombus during Liver Transplantation
1Division of Transplant & Hepatobiliary Surgery, UC San Diego Health, La Jolla, CA
2Pharmacy Inpatient Services, UC San Diego Health, La Jolla, CA
3Anesthesiology, UC San Diego Health, La Jolla, CA.
Meeting: 2018 American Transplant Congress
Abstract number: A241
Keywords: Anticoagulation, Blood transfusion, Hemodynamics, Mortality
Session Information
Session Name: Poster Session A: Liver Retransplantation and Other Complications
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Background
Patients with ESLD often have imbalance in hemostasis & monitoring traditional coagulation lab markers are generally not helpful. Intracardiac thrombus (ICT) during liver transplant (LT) is a life-threatening complication with incidence 0.71-6.25% & high morality 68-82%. The etiology of ICT in LT is unclear. 4F-PCC (Kcentra®) is sometimes used as alternative to FFP for bleeding or to correct “coagulopathy” prior to invasive procedures. The safety of 4F-PCC use days before LT has not been previously investigated.
Methods
This is a single center retrospective analysis of 30 consecutive LT recipients performed from 7/2016–8/2017. Exclusion criteria: those ≤18 yo or received combined heart+LT. Patients with ICT or unexplained MI (n=6) were compared to those without (n=24). Data analyzed include age, sex, etiology of ESLD, days hospitalized before LT, presence of HCC, MELD, dialysis, infection, history of thrombus/GI bleed/TIPS, recent exposure to octreotide, 4F-PCC or antifibrinolytic, use of veno-venous bypass, & blood product use (PRBC, FFP, PLTs, cryoprecipitate) during LT.
Results
A notable rise in ICT was observed in LT during study period. when 4F-PCC use increased. 5 patients (16.7%) developed ICT & 1 (3.3%) had unexplained MI consistent with ICT. All observed ICTs occurred in right side of heart with 17% mortality. 4F-PCC use within 14 days of LT was associated with ICT in LT (83 vs 21%;p=0.004). 5 patients in each group received 4F-PCC. The average total dose (1953 vs 1781 units), number of doses administered (1.7 vs 1.6), and median number of days given prior to LT (6.5 vs 4) were not significantly different. History of GI bleed was associated with ICT (83 vs 25%;p=0.008) consistent with previous reports. In addition, there was a trend suggesting dialysis (83 vs 42%;p=0.07) could be associated with ICT. The number of PRBCs and FFP given during LT were higher in the ICT group but more appeared to be given after observed ICT/MI event & therefore not contributory.
Conclusion
This is the first study demonstrating 4F-PCC exposure is associated with ICT during liver transplantation. Further studies are needed to elucidate the mechanism of this finding, but pre-operative use of 4F-PCC for liver transplantation warrants caution.
CITATION INFORMATION: Misel M., Schnickel G., Berumen J., Sanchez R., Mekeel K. Recent Exposure to Four-Factor Prothrombin Complex Concentrate (4F-PCC) is Associated with Intracardiac Thrombus during Liver Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Misel M, Schnickel G, Berumen J, Sanchez R, Mekeel K. Recent Exposure to Four-Factor Prothrombin Complex Concentrate (4F-PCC) is Associated with Intracardiac Thrombus during Liver Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/recent-exposure-to-four-factor-prothrombin-complex-concentrate-4f-pcc-is-associated-with-intracardiac-thrombus-during-liver-transplantation/. Accessed May 11, 2025.« Back to 2018 American Transplant Congress