Abdel-Wahab OI, Healy B, Dzik WH. Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities

Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Transfusion (Impact Factor: 3.23). 09/2006; 46(8):1279-85. DOI: 10.1111/j.1537-2995.2006.00891.x
Source: PubMed

ABSTRACT Fresh-frozen plasma (FFP) is frequently transfused to patients with mild prolongation of coagulation values under the assumption that FFP will correct the coagulopathy. There is little evidence to support this practice, however. To determine the effect of FFP on coagulation variables and correlation with bleeding in patients with mildly prolonged coagulation values, a prospective audit of all FFP transfusions at the Massachusetts General Hospital between September 2, 2004, and September 30, 2005, was performed.
All patients transfused with FFP for a pretransfusion prothrombin time (PT) between 13.1 and 17 seconds (international normalized ratio [INR], 1.1-1.85) and with a follow-up PT-INR within 8 hours of transfusion were included. Of 1091 units of FFP transfused, follow-up coagulation values within 8 hours were available for 121 patients (324 units).
Transfusion of FFP resulted in normalization of PT-INR values in 0.8 percent of patients (95% confidence interval [CI], 0.0020-0.045) and decreased the PT-INR value halfway to normalization in 15.0 percent of patients (95% CI, 0.097-0.225). Median decrease in PT was 0.20 seconds (median decrease in INR, 0.07). Pretransfusion PT-INR, partial thromboplastin time, platelet count, and creatinine values had no correlation with red blood cell loss.
It is concluded that transfusion of FFP for mild abnormalities of coagulation values results in partial normalization of PT in a minority of patients and fails to correct the PT in 99 percent of patients.

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    • "In less dramatic situations, the impact of plasma transfusions on coagulation tests has only been explored since 2006, when Abdel-Wahab et al. assessed the effect of plasma on INR in an adult critical care unit [14]. Among 121 critically ill adults who received plasma for moderately abnormal coagulation tests (INR < 1.85), only one (0.8%) was able to correct his INR (<1.1) after a plasma transfusion. "
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    ABSTRACT: Whereas red blood cell transfusions have been used since the 19th century, plasma has only been available since 1941. It was originally mainly used as volume replacement, mostly during World War II and the Korean War. Over the years, its indication has shifted to correct coagulation factors deficiencies or to prevent bleeding. Currently, it remains a frequent treatment in the intensive care unit, both for critically ill adults and children. However, observational studies have shown that plasma transfusion fail to correct mildly abnormal coagulation tests. Furthermore, recent epidemiological studies have shown that plasma transfusions are associated with an increased morbidity and mortality in critically ill patients. Therefore, plasma, as any other treatment, has to be used when the benefits outweigh the risks. Based on observational data, most experts suggest limiting its use either to massively bleeding patients or bleeding patients who have documented abnormal coagulation tests, and refraining for transfusing plasma to nonbleeding patients whatever their coagulation tests. In this paper, we will review current evidence on plasma transfusions and discuss its indications.
    Annals of Intensive Care 06/2013; 3(1):16. DOI:10.1186/2110-5820-3-16 · 3.31 Impact Factor
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    • "Administering fresh frozen plasma (FFP) in patients with minimally elevated International Normalized Ratio (INR) values has been shown to be ineffective in producing meaningful corrections [4] [5]. Commonly recommended doses vary between 10 and 30 mL/kg [6] [7]. "
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    ABSTRACT: The use of prothrombin complex concentrates (PCCs) and fibrinogen concentrates (FIBCs) to achieve hemostasis in the perioperative setting as alternatives to allogeneic blood products remains controversial. To examine the efficacy and safety of PCCs and FIBCs, we conducted a systematic review-in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement-to compare the use of these transfusion alternatives in bleeding surgical patients. We performed a literature search of English articles published between July 1997 and July 2012 in MEDLINE via PubMed, The Cochrane Library, and CINAHL. Five randomized trials and 15 nonrandomized studies with a comparator group were included in the final review. Studies were sorted into 1 of the following 3 clinical settings: cardiac surgery, non-cardiac surgery, and reversal of warfarin anticoagulation. Risk of bias was assessed using the Cochrane risk of bias tool. With the exception of 2 randomized controlled trials, the existing body of literature on the use of PCCs and FIBCs in the perioperative setting was assessed to have a high degree of methodological bias. Overall, prospective studies in the cardiac surgery grouping suggested that patients receiving FIBC and/or PCCs required less allogeneic blood transfusion and had less chest tube drainage. In studies of warfarin reversal, PCCs more rapidly corrected the International Normalized Ratio compared to plasma; however, in the setting of intracranial hemorrhage, functional outcomes were poor regardless of the reversal strategy. With regards to safety outcomes, reporting was not uniform and raises concerns of underreporting. Adequately powered, methodologically sound trials would be required for more definitive conclusions to be drawn about the efficacy of PCCs and FIBC over conventional blood components for the treatment of perioperative coagulopathy in bleeding patients.
    Transfusion medicine reviews 02/2013; 27(2). DOI:10.1016/j.tmrv.2013.01.002 · 2.92 Impact Factor
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    • "ble for a lack of correlation between mild-to-moderate coagulation test abnormalities and the development of procedural bleeding or need for red blood cell administration [32] [33]. "
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    ABSTRACT: Allogeneic blood transfusion increases the incidence of tumor recurrence and affects survival of patients undergoing liver resection. Acute normovolemic heamodilution (ANH) helps to decrease the exposure to allogeneic transfusion. This technique in cirrhotic patients undergoing major liver resection may compromise the coagulation process. Study of coagulation effects of ANH using rotation thromboelastometry (ROTEM), which provides global evaluation of coagulation function, may add beneficial effects.
    Egyptian Journal of Anaesthesia 01/2013; 29(1):53-60. DOI:10.1016/j.egja.2012.08.004
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