Fresh frozen plasma: Friend or faux pas in critical illness?*

Stanworth, Simon; Walsh, Timothy

doi:10.1097/01.ccm.0000186730.64411.46

Cited by 8 publications

(9 citation statements)

References 16 publications

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“…We believe that our data are consistent with previous reports with regard to the low observed bleeding risk but differ from previous reports in the clear separation of FFP recipients vs non-FFP recipients coupled with INR stratification. Our results support the position that prophylactic plasma transfusion in this context is not efficacious [19] and potentially dangerous [20] and should be actively discouraged when the INR is less than 3.0 and used highly selectively in patients with higher INRs.…”

Section: Discussionsupporting

confidence: 81%

Central line placement in patients with and without prophylactic plasma

Carino¹,

Tsapenko²,

Sweeney³

2012

Journal of Critical Care

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Section: Discussionsupporting

confidence: 81%

Central line placement in patients with and without prophylactic plasma

Carino¹,

Tsapenko²,

Sweeney³

2012

Journal of Critical Care

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“…Fibrin deposition is known to cause diffuse obstruction of the microvascular bed resulting in progressive organ dysfunction, such as the development of renal insufficiency, pulmonary and cardiovascular failure [1][2][3]23]. Moreover, avoidance of fresh frozen plasma transfusions or administration of prothrombin complex may further reduce the incidence of transfusion-related [24] and thromboembolic complications [25], respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Liberate transfusion of fresh frozen plasma or administration of prothrombin complex in patients with hypercoagulability may aggravate intravascular clot formation and perpetuate microcirculatory failure [23]. Fibrin deposition is known to cause diffuse obstruction of the microvascular bed resulting in progressive organ dysfunction, such as the development of renal insufficiency, pulmonary and cardiovascular failure [1][2][3]23].…”

Section: Discussionmentioning

confidence: 99%

Uncovering Hypercoagulability in Sepsis Using ROTEM® Thromboelastometry: A Case Series

Luckner¹,

Mayr²,

Fries³

et al. 2008

TOCCMJ

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This case series presents three patients with sepsis/septic shock in whom standard coagulation tests (international normalized ratio, activated partial thromboplastin time, fibrinogen, antithrombin, thrombocytes) and ROTEM ® thromboelastometry (InTEM, ExTEM, FibTEM) were simultaneously performed. Although all patients showed significantly prolonged plasmatic coagulation times with a putatively increased risk of bleeding, ROTEM ® thromboelastometry revealed normal clotting times and even signs of hypercoagulability. Therefore, no coagulation active therapy was performed in any patient, not even before invasive procedures or major surgical interventions. No bleeding occurred in any study patient during surgery or the subsequent stay on the intensive care unit. These observations suggest that some critically ill patients with sepsis and abnormal standard coagulation tests may in fact have hypercoagulability. ROTEM ® thromboelastometry can add important information in these patients and enable that blood products are used targeted and only for substitution of relevant deficencies. Future studies are necessary to validate these preliminary findings.

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“…Most traumatic deaths from haemorrhage occur within the first several hours of admission [11–14], and patients with severe internal bleeding may not initially be recognized to be at risk for massive bleeding, coagulopathy and shock. Contrarily, inappropriate transfusion of plasma in non‐bleeding patients can lead to increased infections rates or lung injury [15–18]. As a result, early identification of patients who might benefit or be harmed from the use of haemostatic resuscitation principles or increased plasma is critical in order to attempt to prevent death from haemorrhage and decrease the risks associated with increased plasma transfusion.…”

Section: Introductionmentioning

confidence: 99%

The effect of FFP:RBC ratio on morbidity and mortality in trauma patients based on transfusion prediction score

et al. 2011

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Background and Objectives The empiric use of a high plasma to packed red-blood-cell [fresh frozen plasma:red-blood-cells (FFP:RBC)] ratio in trauma resuscitation for patients with massive bleeding has become well accepted without clear or objective indications. Increased plasma transfusion is associated with worse outcome in some patient populations. While previous studies analyse only patients who received a massive transfusion, this study analyses those that are at risk to receive a massive transfusion, based on the trauma-associated severe haemorrhage (TASH) score, to objectively determine which patients after severe trauma would benefit or have increased complications by the use of a high FFP:RBC ratio. Methods Multicentre retrospective study from the Trauma Registry of the German Trauma Society. Multivariate logistic regression and statistical risk adjustments utilized in analyses. Results A high ratio of FFP:RBC in the ≥15 TASH group was independently associated with survival, with an odds ratio of 2.5 (1.6–4.0), while the <15 TASH group was associated with increased multi-organ failure, 47% vs. 38%, (P <0.005). Conclusions A predictive model of massive transfusion upon admission might be able to rapidly identify which severe trauma patients would benefit or have increased complications from the immediate application of a high ratio of FFP:RBCs. This study helps to identify the appropriate population for a prospective, interventional trial.

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Fresh frozen plasma: Friend or faux pas in critical illness?*

Cited by 8 publications

References 16 publications

Central line placement in patients with and without prophylactic plasma

Central line placement in patients with and without prophylactic plasma

Uncovering Hypercoagulability in Sepsis Using ROTEM® Thromboelastometry: A Case Series

The effect of FFP:RBC ratio on morbidity and mortality in trauma patients based on transfusion prediction score

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