Evaluation of the appropriateness of frozen plasma usage after introduction of prothrombin complex concentrates: a retrospective study

Shih, Andrew W.; Kolesar, Emma; Ning, Shuoyan; Manning, Neal; Arnold, Donald M.; Crowther, Mark

doi:10.1111/vox.12226

Cited by 10 publications

(8 citation statements)

References 38 publications

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“…These findings add to the current literature that suggests that patients with minor INR abnormalities do not demonstrate any significant correction of their coagulation times with transfusion . Because the reagents used to perform coagulation time tests are so sensitive to even minor reductions in coagulation factor levels, and because the relationship between coagulation factor levels and coagulation test times is nonlinear, plasma transfusions often result in only minimal change in coagulation test results in patients who have only minor abnormalities (i.e., INR < 2) at baseline . Coagulation tests should not be used as the sole guide to ordering FP transfusions, as they fail to predict bleeding in clinical studies .…”

Section: Discussionmentioning

confidence: 70%

“…24,25 Because the reagents used to perform coagulation time tests are so sensitive to even minor reductions in coagulation factor levels, and because the relationship between coagulation factor levels and coagulation test times is nonlinear, plasma transfusions often result in only minimal change in coagulation test results in patients who have only minor abnormalities (i.e., INR < 2) at baseline. 26,27 Coagulation tests should not be used as the sole guide to ordering FP transfusions, as they fail to predict bleeding in clinical studies. 28 This study is unique in its audit of FP, CRYO, and rVIIa use in pediatric patients due to its prospective design, combined with adjudication of appropriateness based on pediatric-specific criteria that were found to have good interobserver reliability.…”

Section: Discussionmentioning

confidence: 99%

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Utilization of frozen plasma, cryoprecipitate, and recombinant factor VIIa for children with hemostatic impairments: An audit of transfusion appropriateness

Lieberman

Lin

Cserti‐Gazdewich

et al. 2017

Pediatric Blood & Cancer

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FP, CRYO, and rVIIa are most commonly used in the operating room and intensive care units. FP was often used for fluid resuscitation and for patients with mild to no bleeding. FP was only effective in lowering the INR when the INR was over 2.0. Use of rVIIa was rarely ordered for an appropriate indication. Results of this study inform its readers where trials of pediatric transfusion should be performed to clarify how these products should be used in clinical practice.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Utilization of frozen plasma, cryoprecipitate, and recombinant factor VIIa for children with hemostatic impairments: An audit of transfusion appropriateness

Lieberman

Lin

Cserti‐Gazdewich

et al. 2017

Pediatric Blood & Cancer

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“…[9] Yet, study after study demonstrates that these guidelines are often not followed. [10111213] Clinical practice is hard, but not impossible, to change. One proven strategy combines education with active enforcement and monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…The current American College of Chest Physicians (ACCP), American College of Cardiology (ACC), and American Heart Association (AHA) guidelines emphasize the futility of plasma transfusions in patients on warfarin when the INR is <2.0 and the patient is not bleeding or when there is sufficient time (24 h or more) to reverse warfarin effects by Vitamin K injections. [9] Yet, audit after audit from North America[1011] to Pakistan[12] and India[13] shows that these guidelines are oftentimes not followed and patients receive plasma for warfarin-reversal inappropriately.…”

Section: Introductionmentioning

confidence: 99%

Reversal of warfarin-coagulopathy: How to improve plasma transfusion practice in a community hospital setting?

Munshi

Thyagarajan

Jacob

et al. 2019

Asian J Transfus Sci

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BACKGROUND:Plasma is often given inappropriately to reverse warfarin-induced coagulopathy, wasting health-care resources and exposing the patients to transfusion-associated risks.AIMS:The clinical practice at our institution was evaluated in order to reduce the number of unnecessary plasma transfusions.MATERIALS AND METHODS:Retrospective audit of plasma transfusions was done (July 2014 to June 2015).DESIGN:To improve the clinical practice, a two-prong strategy was implemented: (1) in-service was given to clinicians on the warfarin-reversal guidelines and (2) for a 30-day period, plasma orders were placed on the approval list of the Transfusion Medicine Service.RESULTS:Of the 729 units of plasma, 189 (26% of total) were given for the reversal of warfarin-induced coagulopathy. The medical charts of these patients were reviewed: 46 units of plasma (~25%) were given inappropriately (e.g., patients with minimally elevated international normalized ratio, no evidence of bleeding, and no surgery within 24 h). To check the effectiveness of our intervention, two audits of plasma transfusions were done. During the first audit (January 1–February 29, 2016), 24 patients received plasma to reverse warfarin-coagulopathy. Medical chart review revealed that the vast majority of plasma orders (96.66%) followed the guidelines. A second audit was carried out a year later (January 1–March 31, 2017): during this 3-month period, 47 patients were transfused with plasma for warfarin reversal with a 94% adherence to the guidelines.CONCLUSION:We conclude that plasma transfusion practices may be improved by a combination of education and active enforcement of warfarin reversal guidelines.

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“…Key quality indicators (KQIs) may help centres perform such assessments of current practice, benchmark performance and drive initiatives for continuous improvement to best practice (Arah et al ., ). An example of a KQI for overall plasma transfusion appropriateness is the proportion of plasma transfusions given when international normalized ratios are significantly elevated when there is significant bleeding or an upcoming emergency procedure (Lauzier et al ., ; Shih et al ., ). Our study aims to describe the AB plasma appropriateness index (ABAI) as a KQI to document the appropriate use of group AB plasma to either patients with unknown blood group and/or patients specifically requiring group AB plasma use in our centre and to describe the effects of instituting group A plasma for emergency release in bleeding trauma patients as an intervention following ABAI assessment to mitigate inappropriate AB plasma transfusion.…”

mentioning

confidence: 97%

Reducing AB plasma utilisation through the AB plasma appropriateness index

Khan

Rosinski

Petraszko

et al. 2019

Transfusion Medicine

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Objectives:We hypothesised that there was inappropriate group AB plasma used in our hospital, identifiable by a novel key quality indicator (KQI) and mitigable through massive transfusion protocol (MTP) modification.Background: Group AB plasma is a scarce resource strained by increasing usage worldwide when used as universal donor plasma in non-group AB patients. To reduce inappropriate use and to promote benchmarking to the best practice, we developed the AB plasma appropriateness index (ABAI). ABAI is the ratio of AB plasma transfused to group AB or unknown blood group patients to all AB plasma utilised, where values closer to 1 are better.Methods: Data collected included AB plasma disposition by blood group, indications for transfusion, total blood utilisation, patient clinical characteristics and outcomes. ABAI during a 12-month period was retrospectively assessed, which led to implementation of pre-thawed group A plasma instead of group AB plasma for trauma patients starting in July 2017. Results:The ABAI retrospectively showed inappropriate use in non-group AB patients in our hospital, the majority used to avoid expiry after thaw. When comparing 1-year pre-and post-implementation periods, ABAI improved from 0·464 to 0·900 (P < 0·0001). After exclusion of therapeutic plasma exchange, ABAI still improved (0·486-0·720, P < 0·0001). No differences in the length of stay or mortality associated in 32 patients receiving group A plasma for emergency release were observed. Conclusion:The ABAI is a novel KQI to indicate inappropriate AB plasma usage for quality improvement. This led to thawed A plasma use for MTPs, reducing inappropriate AB plasma usage.

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Evaluation of the appropriateness of frozen plasma usage after introduction of prothrombin complex concentrates: a retrospective study

Cited by 10 publications

References 38 publications

Utilization of frozen plasma, cryoprecipitate, and recombinant factor VIIa for children with hemostatic impairments: An audit of transfusion appropriateness

Utilization of frozen plasma, cryoprecipitate, and recombinant factor VIIa for children with hemostatic impairments: An audit of transfusion appropriateness

Reversal of warfarin-coagulopathy: How to improve plasma transfusion practice in a community hospital setting?

Reducing AB plasma utilisation through the AB plasma appropriateness index

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