{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T15:22:11Z","timestamp":1788621731968,"version":"build-2803163510"},"reference-count":38,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Cardiol"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Excessive bleeding and coagulopathy frequently occur after cardiac surgery, and Fresh Frozen Plasma (FFP) remains the standard treatment. Prothrombin Complex Concentrates (PCC) present a potential alternative; however, their effectiveness and safety compared to FFP remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Electronic databases, including PubMed, Cochrane Central, and ScienceDirect, were searched from inception till April 2025. The risk ratios (RR) and mean differences (MD) were pooled using the random-effects model in Review Manager software for the dichotomous and continuous outcomes, respectively. Leave-one-out sensitivity analysis and GRADE assessment were performed to evaluate the cause of heterogeneity and assess the certainty of evidence, respectively. Publication bias was evaluated visually through funnel plots and statistically through Egger\u2019s regression test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      This meta-analysis included 9 studies\u2014comprising 4 randomized controlled trials and 5 observational studies\u2014covering a total of 1920 patients. PCC is associated with a significant reduction in chest tube drainage output within 24\u2009hours compared to FFP (MD \u2212170.05, 95% CI, \u2212253.54 to \u221286.56;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.0001;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200938%). Similarly, the number of RBC units transfused (MD \u22121.06, 95% CI, \u22121.57 to \u22120.55,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.0001;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200945%) and number of patients requiring RBC transfusion (RR 0.84, 95% CI, 0.77-0.92;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.0001;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200947%) within first 24\u2009hours are both reduced significantly in the PCC arm. Other outcomes including stroke (RR 1.03, 95% CI, 0.63-1.69;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.90;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), thromboembolic events (RR 1.11, 95% CI, 0.76-1.64;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.59;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), and all-cause mortality within 30\u2009days (RR 1.03, 95% CI 0.73-1.45;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.87;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%) were comparable between both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>PCC significantly reduced the chest tube drainage output along with the number of RBC units transfused and the number of patients requiring RBC transfusion within the first 24\u2009hours. In contrast, stroke, other thromboembolic events, and all-cause mortality were comparable between the 2 groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11795468251391024","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T13:09:16Z","timestamp":1763730556000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Prothrombin Complex Concentrate Versus Fresh Frozen Plasma in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"19","author":[{"given":"Muhammad","family":"Hassan Waseem","sequence":"first","affiliation":[{"name":"Allama Iqbal Medical College, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain ul","family":"Abideen","sequence":"additional","affiliation":[{"name":"King Edward Medical University, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameer Haider","family":"Cheema","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areeba","family":"Shoaib","sequence":"additional","affiliation":[{"name":"Dow Medical College, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiman","family":"Waheed","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical University, Rawalpindi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Mukhlis","sequence":"additional","affiliation":[{"name":"Ayub Medical College Abbottabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barka","family":"Sajid","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sania","family":"Aimen","sequence":"additional","affiliation":[{"name":"Quetta Institute of Medical Sciences, Quetta, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2085-8739","authenticated-orcid":false,"given":"Pawan Kumar","family":"Thada","sequence":"additional","affiliation":[{"name":"Sotang Primary Hospital, Solukhumbu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(96)70380-X"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0b013e32835f4d5b"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2012.03663.x"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)62197-7"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/1477-9560-12-8"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001875"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-1172-6"},{"issue":"11","key":"e_1_3_2_9_2","article-title":"Prothrombin complex concentrate in cardiac surgery for the treatment of coagulopathic bleeding","volume":"11","author":"Hayes K","year":"2022","unstructured":"Hayes K, Fernando MC, Jordan V. Prothrombin complex concentrate in cardiac surgery for the treatment of coagulopathic bleeding. Cochrane Database Syst Rev. 2022;11(11):Cd013551.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14991"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.5090\/jcs.23.081"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_3_2_13_2","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins Jpt","unstructured":"Higgins Jpt, Tj CJ, Cumpston M, Li T, Page MJ, et al Cochrane Handbook for Systematic Reviews of Interventions. Wiley."},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1080\/02763869.2019.1588072"},{"key":"e_1_3_2_15_2","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne JA","year":"2016","unstructured":"Sterne JA, Hern\u00e1n MA, Reeves BC, et al ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.","journal-title":"BMJ"},{"key":"e_1_3_2_16_2","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne JAC","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, et al RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.","journal-title":"BMJ"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.3936"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.3501"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15327"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.2235"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivs224"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000689"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.02.017"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-021-02123-x"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/CRD.0000000000000973"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.10.013"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2017.05.044"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.698977"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/trf.13191"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181844677"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2023.03.020"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000608"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atssr.2023.06.006"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1423-0410.2010.01339.x"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2022.05.048"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivs050"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001188"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15167"}],"container-title":["Clinical Medicine Insights: Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795468251391024","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11795468251391024","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795468251391024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:13:56Z","timestamp":1777389236000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11795468251391024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":38,"alternative-id":["10.1177\/11795468251391024"],"URL":"https:\/\/doi.org\/10.1177\/11795468251391024","relation":{},"ISSN":["1179-5468","1179-5468"],"issn-type":[{"value":"1179-5468","type":"print"},{"value":"1179-5468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]},"article-number":"11795468251391024"}}