Conclusion
The review concludes that the institution’s operatively timed weight based PCC4 dosing protocol is medically feasible, safe, and may further reduce post-operative bleeding and the associated complications of significant blood product transfusion. Intraoperative PCC4 was well tolerated. There was a trend towards an overall therapeutic benefit with a slowed rate of postoperative chest tube output (approximately 32ml/hr). We observed no increase in adverse events. An adequately powered randomized controlled trial comparing the observed intraoperative dose and timing of PCC4 versus traditional interventional bleeding management with blood product transfusion following high risk cardiothoracic surgery is recommended.