{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T20:12:54Z","timestamp":1783455174243,"version":"3.55.0"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bleeding after cardiopulmonary bypass in pediatric patients undergoing pulmonary artery reconstruction is a major source of morbidity. Factor concentrates have emerged as off\u2010label therapy to achieve hemostasis while minimizing transfusion. In 2020, our institution implemented a standardized hemostasis management pathway combining factor concentrates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study evaluates the impact of the pathway on blood product transfusion and thromboembolism for patients undergoing pulmonary artery reconstruction with cardiopulmonary bypass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective propensity score\u2010matched cohort study comparing pediatric patients undergoing pulmonary artery reconstruction before and after pathway implementation. The pre\u2010pathway cohort received activated 4\u2010factor prothrombin complex concentrate for refractory bleeding with variable dosing, whereas the post\u2010pathway cohort received both fibrinogen and activated 4\u2010factor prothrombin complex concentrates in standardized doses. The primary efficacy outcome was total blood product transfused after cardiopulmonary bypass. The primary safety outcome was thromboembolism incidence at seven and 30\u2009days postoperatively. Secondary outcomes included 24\u2010h chest tube output, time to extubation, length of stay, 30\u2010day mortality, and acute kidney injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 97 pre\u2010pathway patients and 178 post\u2010pathway patients were included in the final data set for statistical analysis. After propensity score matching, 87 patients remained in each cohort. The post\u2010pathway cohort was associated with a statistically significant reduction in total blood products transfused (30.4\u2009mL\/kg vs. 47.9\u2009mL\/kg, mean difference 17.6\u2009mL\/kg, 95% CI [9.82\u201325.9],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). There was no statistically significant difference in seven\u2010day (11.5% post\u2010pathway vs. 8.0% pre\u2010pathway, OR 1.48, 95% CI 0.51\u20134.32,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.468) or 30\u2010day (18.4% post\u2010pathway vs. 9.2% pre\u2010pathway, OR 2.23, 95% CI 0.84\u20135.87,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.106) thromboembolism rates. There were no significant differences in secondary outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A hemostasis management pathway utilizing combined factor concentrates was associated with significantly reduced post\u2010bypass transfusion requirements in pediatric pulmonary artery reconstruction. We observed a higher incidence of post\u2010operative thromboembolism, with a twofold increase at 30\u2009days, although statistical significance was not reached. The majority of post\u2010operative thromboembolism was associated with indwelling lines. Prospective multicenter studies are needed to validate safety, efficacy and generalizability of utilizing combined factor concentrates in pediatric patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70201","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T12:46:38Z","timestamp":1777034798000},"page":"974-982","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Utilizing Combined Factor Concentrates for Hemostasis Management in Pediatric Pulmonary Artery Reconstruction: A Propensity Score\u2010Matched Cohort Study"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2278-8524","authenticated-orcid":false,"given":"Kaitlin M.","family":"Flannery","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A.","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Echo V.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianne M.","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sa","family":"Shen","sequence":"additional","affiliation":[{"name":"Quantitative Sciences Unit Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank L.","family":"Hanley","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan","family":"Margetson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Perfusion, Stanford Hospitals and Clinics Stanford Children's Hospital  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6524-6640","authenticated-orcid":false,"given":"Manchula","family":"Navaratnam","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.03.105"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13158"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-020-01217-1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000007038"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.03.083"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.006304"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/2150135118754522"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/202254330"},{"issue":"1","key":"e_1_2_8_10_1","first-page":"19","article-title":"KDIGO Clinical Practice Guidelines for Acute Kidney Injury","volume":"2","year":"2012","journal-title":"Kidney International. 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