Magic in a bottle? A Focused review of factor concentrates for the intraoperative treatment of acquired coagulopathy – Fibrinogen concentrate, prothrombin complex concentrate, and recombinant activated factor VII

Goal-directed administration of blood components including red cells, platelets, plasma, and factor concentrates plays a critical role in the management of intraoperative coagulopathy. Increasingly commonly used, purified and recombinant factor concentrates are being recognized for their logistical advantages and potentially superior efficacy. Three- and four-factor prothrombin concentrates, fibrinogen concentrates and activated factor VII have an evolving evidence base relative to frozen plasma and cryoprecipitate. This review discusses these compounds, compares them to conventional blood products, discusses the trial data supporting their use, and reviews indications for intraoperative transfusion based on point-of-care testing and conventional laboratory results. While factor concentrates have become an increasingly popular option for treating acquired factor deficiency in surgical patients, evidence is evolving and clinical trial data in one surgical patient population may not be transferable to another. High quality clinical studies will help optimize management of coagulopathy and improve patient outcomes while decreasing any associated risks.