Prothrombin Complex Concentrate Versus Fresh Frozen Plasma in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

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Background: Excessive bleeding and coagulopathy frequently occur after cardiac surgery, and Fresh Frozen Plasma (FFP) remains the standard treatment. Prothrombin Complex Concentrates (PCC) present a potential alternative; however, their effectiveness and safety compared to FFP remain uncertain. Methods: Electronic databases, including PubMed, Cochrane Central, and ScienceDirect, were searched from inception till April 2025. The risk ratios (RR) and mean differences (MD) were pooled using the random-effects model in Review Manager software for the dichotomous and continuous outcomes, respectively. Leave-one-out sensitivity analysis and GRADE assessment were performed to evaluate the cause of heterogeneity and assess the certainty of evidence, respectively. Publication bias was evaluated visually through funnel plots and statistically through Egger’s regression test. Results: This meta-analysis included 9 studies—comprising 4 randomized controlled trials and 5 observational studies—covering a total of 1920 patients. PCC is associated with a significant reduction in chest tube drainage output within 24 hours compared to FFP (MD −170.05, 95% CI, −253.54 to −86.56; P < .0001; I 2 = 38%). Similarly, the number of RBC units transfused (MD −1.06, 95% CI, −1.57 to −0.55, P < .0001; I 2 = 45%) and number of patients requiring RBC transfusion (RR 0.84, 95% CI, 0.77-0.92; P < .0001; I 2 = 47%) within first 24 hours are both reduced significantly in the PCC arm. Other outcomes including stroke (RR 1.03, 95% CI, 0.63-1.69; P = .90; I 2 = 0%), thromboembolic events (RR 1.11, 95% CI, 0.76-1.64; P = .59; I 2 = 0%), and all-cause mortality within 30 days (RR 1.03, 95% CI 0.73-1.45; P = .87; I 2 = 0%) were comparable between both groups. Conclusion: PCC significantly reduced the chest tube drainage output along with the number of RBC units transfused and the number of patients requiring RBC transfusion within the first 24 hours. In contrast, stroke, other thromboembolic events, and all-cause mortality were comparable between the 2 groups.

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