{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T18:02:20Z","timestamp":1772647340660,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Major bleeding is a life\u2010threatening complication in pediatric cardiovascular surgery, particularly in neonates and infants with immature coagulation systems and congenital heart defects (<jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>). Cardiopulmonary bypass (<jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content>) exacerbates these risks by depleting coagulation factors and platelets. Four\u2010factor prothrombin complex concentrates (<jats:styled-content style=\"fixed-case\">4F<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCC<\/jats:styled-content>) provide targeted hemostatic correction but carry potential thrombotic risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Among 1296 pediatric patients who underwent cardiovascular surgery between January 2018 and April 2024, a retrospective cohort study analyzed 104 patients who received <jats:styled-content style=\"fixed-case\">4F<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCC<\/jats:styled-content>. Patients were grouped into low\u2010dose (&lt;\u200935\u2009U\/kg) and high\u2010dose (\u2265\u200935\u2009U\/kg). Thrombotic complications were evaluated within 15\u2009days after use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age was 1\u2009month (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>: 0\u20137.5), and 69.23% of patients were male. Common diagnoses included hypoplastic left heart syndrome (14.42%), ventricular septal defect (13.46%), and coarctation of the aorta (12.5%). Frequent procedures included Norwood procedure (14.42%) and ventricular septal defect closure (13.46%). Thrombotic complications occurred in 6.73% overall, with no significant differences between high\u2010dose (5.26%) and low\u2010dose (8.51%) groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.698). High\u2010dose <jats:styled-content style=\"fixed-case\">4F<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCC<\/jats:styled-content> was associated with shorter <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> times (<jats:italic>p<\/jats:italic>\u2009=\u20090.007) (Cohen's <jats:italic>d<\/jats:italic> 0.537) but higher reintervention rates (57.89% vs. 34.04%; <jats:italic>p<\/jats:italic>\u2009=\u20090.015) (Cram\u00e9r's <jats:italic>V<\/jats:italic> 0.118).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High\u2010dose <jats:styled-content style=\"fixed-case\">4F<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCC<\/jats:styled-content> was not associated with increased thrombotic complications. Thrombotic complications in this study were inferior to all\u2010cause thrombotic complications in pediatric cardiovascular surgery of 11%. These findings support <jats:styled-content style=\"fixed-case\">4F<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCC<\/jats:styled-content> as a viable option for managing severe bleeding in pediatric cardiovascular surgery. Further studies should explore dose optimization and preventive applications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.15118","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T04:15:03Z","timestamp":1748405703000},"page":"619-626","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Thrombotic Complications of Low\u2010Dose Versus High\u2010Dose Four\u2010Factor Prothrombin Complex Concentrate for Massive Bleeding in Pediatric Cardiovascular Surgery"],"prefix":"10.1111","volume":"35","author":[{"given":"Laura","family":"Palacio\u2010Guzm\u00e1n","sequence":"first","affiliation":[{"name":"Anesthesiology Department Fundaci\u00f3n Valle del Lili  Cali Colombia"},{"name":"Universidad Icesi Facultad de Medicina  Cali Colombia"},{"name":"Centro de Investigaciones Cl\u00ednicas Fundaci\u00f3n Valle del Lili  Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6711-127X","authenticated-orcid":false,"given":"Sergio","family":"Alzate\u2010Ricaurte","sequence":"additional","affiliation":[{"name":"Centro de Investigaciones Cl\u00ednicas Fundaci\u00f3n Valle del Lili  Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia","family":"Plata\u2010Ayala","sequence":"additional","affiliation":[{"name":"Anesthesiology Department Fundaci\u00f3n Valle del Lili  Cali Colombia"},{"name":"Universidad Icesi Facultad de Medicina  Cali Colombia"},{"name":"Centro de Investigaciones Cl\u00ednicas Fundaci\u00f3n Valle del Lili  Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andres","family":"Pombo\u2010Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Centro de Investigaciones Cl\u00ednicas Fundaci\u00f3n Valle del Lili  Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1438-2284","authenticated-orcid":false,"given":"Gustavo Adolfo","family":"Cruz\u2010Suarez","sequence":"additional","affiliation":[{"name":"Anesthesiology Department Fundaci\u00f3n Valle del Lili  Cali Colombia"},{"name":"Universidad Icesi Facultad de Medicina  Cali Colombia"},{"name":"Centro de Investigaciones Cl\u00ednicas Fundaci\u00f3n Valle del Lili  Cali 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