Dose‐associated pulmonary complication rates after fresh frozen plasma administration for warfarin reversal

Marshall, Ariela L.; Levine, M.D. Norman; Howell, Melissa L.; Chang, Yuchiao; Riklin, Eric; Parry, Blair A.; Callahan, R.T.; Okechukwu, Ikenna; Ayres, Alison; Nahed, Brian V.; Goldstein, Joshua N.

doi:10.1111/jth.13212

Cited by 36 publications

(28 citation statements)

References 33 publications

(32 reference statements)

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“…In addition, FFP contains only 1 U/mL of AT, so doses of approximately 20 mL/kg could be required to restore AT to normal levels [81]. This can lead to transfusion-associated circulatory overload (TACO) or transfusion-related acute lung injury (TRALI) [82].…”

Section: Heparin Resistancementioning

confidence: 99%

Clinical controversies in anticoagulation monitoring and antithrombin supplementation for ECMO

et al. 2020

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During extracorporeal membrane oxygenation (ECMO), a delicate balance is required to titrate systemic anticoagulation to prevent thrombotic complications within the circuit and prevent bleeding in the patient. Despite focused efforts to achieve this balance, the frequency of both thrombotic and bleeding events remains high. Anticoagulation is complicated to manage in this population due to the complexities of the hemostatic system that are compounded by age-related developmental hemostatic changes, variable effects of the etiology of critical illness on hemostasis, and blood-circuit interaction. Lack of high-quality data to guide anticoagulation management in ECMO patients results in marked practice variability among centers. One aspect of anticoagulation therapy that is particularly challenging is the use of antithrombin (AT) supplementation for heparin resistance. This is especially controversial in the neonatal and pediatric population due to the baseline higher risk of bleeding in this cohort. The indication for AT supplementation is further compounded by the potential inaccuracy of the diagnosis of heparin resistance based on the standard laboratory parameters used to assess heparin effect. With concerns regarding the adverse impact of bleeding and thrombosis, clinicians and institutions are faced with making difficult, real-time decisions aimed at optimizing anticoagulation in this setting. In this clinically focused review, the authors discuss the complexities of anticoagulation monitoring and therapeutic intervention for patients on ECMO and examine the challenges surrounding AT supplementation given both the historical and current perspectives summarized in the literature on these topics.

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Section: Heparin Resistancementioning

confidence: 99%

Clinical controversies in anticoagulation monitoring and antithrombin supplementation for ECMO

et al. 2020

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“…However, the administration of FFP has several potential limitations including the time required to prepare and transfuse it, risk of transfusion reactions, as well as increased incidence of secondary infections, organ failure, and mortality. [3][4][5][6][7][8] Recombinant factor VIIa (rFVIIa) has been suggested as a potential adjunct to FFP transfusion in managing coagulopathy but the cost has limited its use. [9][10][11] Hence, additional adjuncts to treat coagulopathy in critically ill children are necessary.…”

Section: Introductionmentioning

confidence: 99%

Single-Center Use of Prothrombin Complex Concentrate in Pediatric Patients

Karube

Andersen

Tobias

2020

J Pediatr Intensive Care

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Coagulation disturbances frequently occur in critically ill children. Four-factor prothrombin complex concentrate (4F-PCC) may have a potential role in managing these patients while avoiding concerns associated with fresh frozen plasma. However, data on this product in critically ill children is scarce. We retrospectively identified 24 critically ill pediatric patients who received 4F-PCC. The primary indication was to correct coagulopathy and control bleeding in the trauma or surgical setting. 4F-PCC effectively decreased the international normalized ratio level, a surrogate marker of hemostasis. Further study is warranted to identify efficacy, indications, optimal dosing, and adverse effects in the critically ill pediatric patients.

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“…5,6 Massive blood loss during LT is associated with an increased risk of mortality, multiorgan failure, and reduced graft survival. [7][8][9] Although the risk of pathogen transmission is low when allogeneic plasma is used, it is still associated with noninfectious complications, including transfusion-related circulatory overload 10 and transfusion-related acute lung injury. 11 These complications are poorly tolerated by LT patients, especially those with severe portal hypertension, fluid overload, poor renal function, and compromised heart and lung mechanics.…”

Section: Introductionmentioning

confidence: 99%

Utility of prothrombin complex concentrate as first‐line treatment modality of coagulopathy in patients undergoing liver transplantation: A propensity score‐matched study

Srivastava

Agarwal

Jha

et al. 2018

Clinical Transplantation

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Background Transfusion management during liver transplantation (LT) is aimed at reducing blood loss and allogeneic transfusion requirements. Although prothrombin complex concentrate (PCC) has been used satisfactorily in various bleeding disorders, studies on its safety, and efficacy during LT are limited. Methods A retrospective chart review of adult patients who underwent living donor LT at a single institute between October 2016 and January 2018 was carried out. The safety and efficacy of PCC in reducing transfusion requirements intraoperatively in patients who received PCC were compared with patients who did not receive PCC. A propensity score‐matching technique was used, at a 1:1 ratio, to remove selection bias. Results After completing the 1:1 propensity score‐matched analysis, 60 pairs of patients were identified. The use of PCC was associated with significantly decreased red blood cell transfusion requirements (6.2 ± 4.1 vs 8.23 ± 5.18, P < 0.001) and fresh frozen plasma transfusion requirements (2.6 ± 2 vs 6.18 ± 4.1, P < 0.001). The number of patients developing postoperative hemorrhagic complications was higher in the non‐PCC group. Conclusions During LT, the use of PCC led to decreased transfusion requirements. No thromboembolic complications related to PCC were noted in this series.

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Dose‐associated pulmonary complication rates after fresh frozen plasma administration for warfarin reversal

Cited by 36 publications

References 33 publications

Clinical controversies in anticoagulation monitoring and antithrombin supplementation for ECMO

Clinical controversies in anticoagulation monitoring and antithrombin supplementation for ECMO

Single-Center Use of Prothrombin Complex Concentrate in Pediatric Patients

Utility of prothrombin complex concentrate as first‐line treatment modality of coagulopathy in patients undergoing liver transplantation: A propensity score‐matched study

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