Plasma transfusion strategies for critically ill patients

Karam, Oliver; Tucci, Marisa; Combescure, Christophe; Lacroix, Jacques; Rimensberger, Peter C.

doi:10.1002/14651858.cd010654.pub2

Cited by 10 publications

(1 citation statement)

References 28 publications

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“…Perhaps the cornerstone of intraoperative PBM is the tolerance of abnormal laboratory results. 88 In many (nontrauma) operative scenarios, simply delaying red cell transfusion until the hemoglobin reaches 7.0 g/dL, 88,89 or the INR reaches 1.5, 90 can have a tremendous impact on the total amount of blood that is transfused without increasing mortality.…”

Section: Pro: Vhas Should Replace Fixed Transfusion Ratios In Mtps In...mentioning

confidence: 99%

Pro–Con Debate: Viscoelastic Hemostatic Assays Should Replace Fixed Ratio Massive Transfusion Protocols in Trauma

Blaine

Dudaryk

2021

Anesthesia &Amp; Analgesia

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Major trauma patients at risk of traumatic coagulopathy are commonly treated with early clotting factor replacement to maintain hemostasis and prevent microvascular bleeding. In the United States, trauma transfusions are often dosed by empiric, low-ratio massive transfusion protocols, which pair plasma and platelets in some ratio relative to the red cells, such as the "1:1:1" combination of 1 units of red cells, 1 unit of plasma, and 1 donor's worth of pooled platelets. Empiric transfusion increases the rate of overtransfusion when unnecessary blood products are administered based on a formula and not on at patient's hemostatic profile. Viscoelastic hemostatic assays (VHAs) are point-of-care hemostatic assays that provided detailed information about abnormal clotting pathways. VHAs are used at many centers to better target hemostatic therapies in trauma. This Pro/Con section will address whether VHA guidance should replace empiric fixed ratio protocols in major trauma. (Anesth Analg 2022;134:21-31) GLOSSARY ACT = activated clotting time; AUC = area under the curve; CA5 = clot amplitude at 5 min, an early predictor of the maximum clot firmness; CFT = clot formation time (ROTEM); CT = clotting time (ROTEM and Quantra); DOAC = direct-acting oral anticoagulant; EXTEM = extrinsic pathway ROTEM; FCS = fibrinogen contribution to clot stiffness (Quantra); FIBTEM = fibrinogen ROTEM; FP-24 = liquid plasma frozen after 24 hours of collection; INR = international normalized ratio; INTEM = intrinsic pathway ROTEM; ISS = Injury Severity Score; iTACTIC = implementing Treatment Algorithms for the Correction of Trauma-Induced Coagulopathy; K = kinetic time (TEG); LI = lysis index (ROTEM); Ly30 = percent clot lysis at 30 minutes (TEG); MA = maximum amplitude (TEG); MCF = maximum clot firmness (ROTEM); MTP = massive transfusion protocol; NSAID = nonsteroidal anti-inflammatory drug; PBM = patient blood management; PCC = prothrombin complex concentrate; PCS = platelet contribution to clot stiffness (Quantra); PROPPR = Pragmatic Randomized Optimal Platelet and Plasma Ratios; PT = prothrombin time; PTT = partial thromboplastin time; R = reaction time (TEG); ROTEM = rotational thromboelastometry; rTEG = rapid TEG; TEG = thrombelastography; TEG FF = TEG functional fibrinogen; VHA = viscoelastic hemostatic assay

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Section: Pro: Vhas Should Replace Fixed Transfusion Ratios In Mtps In...mentioning

confidence: 99%

Pro–Con Debate: Viscoelastic Hemostatic Assays Should Replace Fixed Ratio Massive Transfusion Protocols in Trauma

Blaine

Dudaryk

2021

Anesthesia &Amp; Analgesia

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Blood Banking Principles and Practices

Wong¹,

Luban²

2016

Lanzkowsky's Manual of Pediatric Hematology and Oncology

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Risk of Procedural Hemorrhage

Wolfe

Kress

2016

Chest

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Patients who are critically ill and hospitalized often require invasive procedures as a part of their medical care. Each procedure carries a unique set of risks and associated complications, but common to all of them is the risk of hemorrhage. Central venous catheterization, arterial catheterization, paracentesis, thoracentesis, tube thoracostomy, and lumbar puncture constitute a majority of the procedures performed in patients who are hospitalized. In this article, the authors will discuss the risk factors for bleeding complications from each of these procedures and methods to minimize risk. Physicians often correct coagulopathy prior to procedures to decrease bleeding risk, but there is minimal evidence to support this practice.

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Plasma transfusion strategies for critically ill patients

Abstract: This review highlights the lack of evidence that is available to guide plasma transfusions in critically ill patients. Randomised controlled trials are needed to determine the appropriate plasma transfusion strategy in critically ill patients.

Cited by 10 publications

References 28 publications

Pro–Con Debate: Viscoelastic Hemostatic Assays Should Replace Fixed Ratio Massive Transfusion Protocols in Trauma

Pro–Con Debate: Viscoelastic Hemostatic Assays Should Replace Fixed Ratio Massive Transfusion Protocols in Trauma

Blood Banking Principles and Practices

Risk of Procedural Hemorrhage

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