Use of Factor Concentrates for the Management of Perioperative Bleeding: Guidance from the ISTH SSC Subcommittee on Perioperative and Critical Care Thrombosis and Hemostasis.

Perioperative bleeding remains a major cause of morbidity and resource utilization in patients undergoing major surgery, including cardiac, trauma, obstetric, and organ transplant. Acquired perioperative coagulopathy is multifactorial and may result from blood loss, hemodilution, hypothermia, acidosis, fibrinolysis, inflammation, and consumption of coagulation factors and platelets. Over the past decade, coagulation factor concentrates have been increasingly incorporated into perioperative bleeding management algorithms due to rapid availability, standardized dosing, lower infusion volumes, and pathogen inactivation, reducing dependence on plasma products. Since the 2018 publication of the International Society on Thrombosis and Haemostasis (ISTH) guidance on the use of factor concentrates for the management of perioperative bleeding, additional clinical studies, systematic reviews, and evolving bleeding management practices have expanded the evidence base regarding use of fibrinogen concentrate, prothrombin complex concentrate (PCC), recombinant activated factor VII (rFVIIa), and factor XIII (FXIII) concentrate for surgically acquired coagulopathy. This guidance document from the Perioperative and Critical Care Subcommittee of the ISTH reviews the contemporary literature and provides pragmatic guidance regarding the perioperative use of coagulation factor concentrates based on available evidence and expert consensus.