Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials

Stanworth, Simon; Brunskill, Susan J; Hyde, Chris; McClelland, D. B. L.; Murphy, Michael

doi:10.1111/j.1365-2141.2004.04973.x

Cited by 371 publications

(275 citation statements)

References 90 publications

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“…It is discouraging, faced with the potential side-effects of FFP, that available data on the efficacy of FFP are scarce [42,43]. Several studies comparing the efficacy of PCCs with human plasma for emergency oral anticoagulant reversal have shown that PCCs provide more effective and more rapid correction of coagulopathy [44-47].…”

Section: Comparing Pccs With Human Plasmamentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

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Prothrombin complex concentrates (PCCs) are used mainly for emergency reversal of vitamin K antagonist therapy. Historically, the major drawback with PCCs has been the risk of thrombotic complications. The aims of the present review are to examine thrombotic complications reported with PCCs, and to compare the safety of PCCs with human fresh frozen plasma. The risk of thrombotic complications may be increased by underlying disease, high or frequent PCC dosing, and poorly balanced PCC constituents. The causes of PCC thrombogenicity remain uncertain but accumulating evidence indicates the importance of factor II (prothrombin). With the inclusion of coagulation inhibitors and other manufacturing improvements, today's PCCs may be considered safer than earlier products. PCCs may be considered preferable to fresh frozen plasma for emergency anticoagulant reversal, and this is reflected in the latest British and American guidelines. Care should be taken to avoid excessive substitution with prothrombin, however, and accurate monitoring of patients' coagulation status may allow thrombotic risk to be reduced. The risk of a thrombotic complication due to treatment with PCCs should be weighed against the need for rapid and effective correction of coagulopathy.

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Section: Comparing Pccs With Human Plasmamentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

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“…A lower thrombocyte transfusion threshold has been shown to be safe in terms of bleeding complications and even superior in order to prevent alloimmunization and refractoriness to platelet transfusion [85]. Most clinical uses of fresh frozen plasma, even those currently recommended by practice guidelines, are not supported by evidence from randomized clinical trials [86].…”

Section: Clinical Studies On Transfusion-related Immunomodulationmentioning

confidence: 99%

Transfusion-transmissible infections and transfusion-related immunomodulation

Buddeberg

Schimmer

Spahn

2008

Best Practice & Research Clinical Anaesthesiology

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Transfusion-transmissible infections and transfusion-related immunomodulation AbstractThe risk of acquiring a transfusion-transmitted infection has declined in recent years. However, after human immunodeficiency virus and hepatitis B and C virus transmission were successfully reduced, new pathogens are threatening the safety of the blood supply, especially in the face of rising numbers of immunocompromised transfusion recipients. Despite new standards in the manufacture and storage of blood products, bacterial contamination still remains a considerable cause of transfusion-related morbidity and mortality. Better allograft survival in kidney transplant patients and higher cancer recurrence rate in surgical oncology patients after allogeneic blood transfusions highlighted a previously underestimated side-effect: transfusion-related immunomodulation (TRIM). The precise pathomechanism still remains uncertain; however, its mostly deleterious effects--such as a higher incidence of postoperative or nosocomial infections--is increasingly accepted. Although transfusion-related immunomodulation is thought to be mediated mainly by donor white blood cells, the benefit of leukoreduction on overall mortality and on infectious complications is highly debatable. Transfusion-transmissible infections and Transfusion-related immunomodulation Transfusion-transmissible infections and Transfusion-related immunomodulation AbstractThe risk of acquiring a transfusion-transmitted infection has declined in recent years.

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“…No studies have shown evidence of a perioperative plasma transfusion benefit. 38 Five trials have compared a plasma group with a control group (no plasma) in patients undergoing cardiopulmonary bypass surgery.…”

mentioning

confidence: 99%

Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: effect on plasma transfusion therapy

Matevosyan¹,

Madden²,

Barnett³

et al. 2011

JNS

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H emostasis is a complex interaction among 1) the fluid phase of procoagulants that generate thrombin, 2) the natural anticoagulants that regulate thrombin, 3) the fibrinolytic system that controls the size of thrombus and maintains vascular patency, and 4) the cellular phase that includes platelets and endothelium. To date, no single global test exists to assess these 4 components of hemostasis. The in vitro coagulation tests, the PT and PTT, were developed to identify the cause of bleeding in a symptomatic bleeding patient; they have never been shown to assess the risk of bleeding in a nonbleeding patient. 16,20,35 Because different sensitivities of tissue thromboplastin reagents account for the variability of PT, the INR was introduced to monitor warfarin therapy. The INR is a calculated value derived by the following formula: (patient PT/mean normal PT) ISI , where ISI is a value assigned to the PT reagent when compared with a WHO reference standard with an ISI of 1.0. 31,43,44 The INR was standardized on plasmas from patients on chronic warfarin therapy that affects only VKD factors II, VII, IX, and X. Use of the INR is therefore inappropriate in other medical conditions in which clotting factors other than VKD factors are affected.10 However, the INR is often (mis)used in clinical practice to assess hemostasis in patients not receiving warfarin therapy; thus, patients with mildly elevated INRs are reflexively transfused with FFP, usually perioperatively.In the past, less-sensitive thromboplastin reagents (ISI > 2.0) caused a prolonged PT only when factor VII Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: effect on plasma transfusion therapy Object. Neurosurgical patients often have mildly prolonged prothrombin time (PT) or international normalized ratio (INR). In the absence of liver disease this mild prolongation appears to be due to the use of very sensitive PT reagents. Therefore, the authors performed relevant coagulation factor assays to assess coagulopathy in such patients. They also compared plasma transfusion practices in their hospital before and after the study.Methods. The authors tested 30 plasma specimens from 25 patients with an INR of 1.3-1.7 for coagulation factors II, VII, and VIII. They also evaluated plasma orders during the 5-month study period and compared them with similar poststudy periods following changes in plasma transfusion guidelines based on the study results.Results. At the time of plasma orders the median INR was 1.35 (range 1.3-1.7, normal reference range 0.9-1.2) with a corresponding median PT of 13.6 seconds (range 12.8-17.6 seconds). All partial thromboplastin times were normal (median 29.0 seconds, range 19.3-33.7 seconds). The median factor VII level was 57% (range 25%-124%), whereas the hemostatic levels recommended for major surgery are 15%-25%. Factors II and VIII levels were also within the hemostatic range (median 72% and 118%, respectively). Based on these scientific data, plasma transfusion guidelines were mod...

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Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials

Cited by 371 publications

References 90 publications

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Transfusion-transmissible infections and transfusion-related immunomodulation

Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: effect on plasma transfusion therapy

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