Resumen

BERRO, Maximiliano. Is it time to replace plasma with prothrombin complex concentrate in cardiac surgery?. Rev.Urug.Cardiol. [online]. 2026, vol.41, n.1, e401.  Epub 01-Dic-2026. ISSN 0797-0048.  https://doi.org/10.29277/cardio.41.1.3.

Postoperative bleeding after cardiac surgery is a common occurrence and is associated with a poorer clinical outcome and increased resource utilization. Although fresh frozen plasma has traditionally been used to replace coagulation factors in cases of coagulopathy, its clinical efficacy is modest and depends on large volumes, increasing the risk of complications. Prothrombin complex concentrate (PCC) provides rapid replacement of vitamin K, dependent coagulation factors in a small volume. Recent evidence -including meta-analyses, observational studies, and randomized controlled trials- shows that PCC reduces bleeding and the need for blood transfusions without increasing thromboembolic events. In patients with significant bleeding and documented coagulopathy (elevated INR and/or abnormal ROTEM results), PCC should be considered as the preferred treatment option, within standardized protocols guided by laboratory or viscoelastic coagulation tests. Uncertainties remain regarding the optimal dose, cost-effectiveness, and safety in high-risk thromboembolic subgroups, which warrant further research.

Palabras clave : CARDIAC SURGERY; CRITICAL BLEEDING; PLASMA; PROTHROMBIN COMPLEX; CONCENTRATE.

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