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Esther Méndez Arias: Why a Lower First Dose of 4F-PCC Works Better After Cardiac Surgery
Esther Méndez Arias/www.curso-patient-blood-management.com
Jul 29, 2026, 14:17

Esther Méndez Arias: Why a Lower First Dose of 4F-PCC Works Better After Cardiac Surgery

Esther Méndez Arias, President of the Transfusion Committe at Bellvitge University Hospital, Coordinator of the Working Group on Digital Transformation and Innovation, Spanish Society of Anaesthesiology at SEDAR, shared Journal Cardiothoracic Vascular Anesthesia‘s post on LinkedIn:

“At our centre, we usually administer 10–15 IU/kg of four-factor prothrombin complex concentrate for bleeding after cardiac surgery, once residual heparin, hypofibrinogenaemia and platelet abnormalities have been corrected.

We then reassess both bleeding and ROTEM findings, and administer a second dose only if microvascular bleeding and coagulopathy consistent with coagulation factor deficiency persist.

For this reason, the median dose of 3,000 IU —approximately 36 IU/kg— used in the retrospective study by Vander Zwaag et al. seems excessive to us as an initial strategy.

We favour a stepwise approach: a low initial dose, early reassessment and redosing only when necessary, without attempting to normalise an isolated EXTEM-CT value.

This is in line with the European consensus by Erdoes et al., developed within the EACTA, which suggests considering an initial dose of 12.5 IU/kg in patients at high thromboembolic risk, such as those undergoing cardiac surgery.”

Journal Cardiothoracic Vascular Anesthesia shared a post on LinkedIn about recent article by Daniel Bolliger et al, published in JCVA, adding:

“How To Dose Prothrombin Complex Concentrates in Bleeding Patients After Cardiac Surgery

How should we dose prothrombin complex concentrate in bleeding cardiac surgery patients?

This editorial argues that ROTEM clotting time poorly reflects thrombin generation, cautioning against high doses and purely viscoelastic-guided dosing.”

Title: How To Dose Prothrombin Complex Concentrates in Bleeding Patients After Cardiac Surgery

Authors: Daniel Bollige, Eckhard Mauermann, Kenichi A. Tanaka

Esther Méndez Arias: Why a Lower First Dose of 4F-PCC Works Better After Cardiac Surgery

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bleeding disorders Blood Daniel Bollige Eckhard Mauermann Esther Méndez Arias Health Hematology Hemophilia Hemostasis Hemostasis News Hemostasis Today Kenichi A. Tanaka Medicine thrombosis
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