Factor Eight Inhibiting Bypass Activity for Refractory Bleeding in Isolated Coronary Artery Bypass Grafting: A Propensity-Matched Analysis
Stevan S. Pupovac, Michael Catalano, Alan R. Hartman, Pey-Jen Yu, MD.
Northshore University Hospital / Northwell Health, Manhasset, NY, USA.
OBJECTIVE: The use of factor eight inhibitor bypassing activity (FEIBA) for managing refractory postoperative bleeding in cardiac surgery has been reported, however, it has never been evaluated in patients undergoing isolated coronary artery bypass grafting (CABG). Concerns remain regarding potential graft thrombosis following administration of a prothrombin factor concentrate. Herein, we report our experience with the use of FEIBA in patients undergoing isolated CABG.
METHODS: A retrospective review was undertaken of all consecutive patients who had undergone isolated on-pump coronary artery bypass grafting between January 2015 and December 2019. Patients requiring intraoperative ECMO support were excluded. Patients were divided into 2 groups, dependent upon whether they received FEIBA: ‘FEIBA’ (n = 63) vs. ‘no FEIBA’ (n = 2493). A 5:1 propensity match analysis was employed, and patients were analyzed with respect to thrombotic complications, reintervention for myocardial ischemia and short-term clinical outcomes.
RESULTS: There was no difference in thirty-day mortality between the two cohorts. There was also no significant difference in a composite of thrombotic complications (comprised of deep vein thrombosis, pulmonary embolism and stroke) between the two groups. Similarly, there were no significant difference in the requirement for postoperative reintervention for myocardial ischemia between patients who received FEIBA versus those who did not.
CONCLUSIONS: FEIBA may be both safe and effective when used as rescue therapy for refractory bleeding following isolated coronary artery bypass grafting.
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