Prophylactic fresh frozen plasma versus prothrombin complex concentrate for preprocedural management of the coagulopathy of liver disease: A systematic review

Evans, Christina R.; Cuker, Adam; Crowther, Mark; Pishko, Allyson M.

doi:10.1002/rth2.12724

Cited by 3 publications

(3 citation statements)

References 43 publications

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“…Other studies have also failed to demonstrate a benefit with this approach and have demonstrated harms with transfusion of fresh frozen plasma (volume overload) or the use of prothrombin complex concentrate (PCC) (increased risk of thromboembolic events) targeted toward normalizing INR. Furthermore, fresh frozen plasma fails to correct an INR >1.5, 12 and correction of the INR with PCCs is only partial, at best. 13 …”

Section: Evaluation and Management Of Bleeding In A Patient Who Is Cr...mentioning

confidence: 99%

How I approach bleeding in hospitalized patients

Bannow

Konkle

2023

Blood

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Excessive bleeding is relatively common in adult inpatients, whether as the primary reason for admission or developing during the hospital stay. Common causes include structural issues, medication effects and systemic illnesses but occasionally unexpected bleeding can develop as a result of an undiagnosed or newly acquired bleeding disorder. The first step in caring for the bleeding inpatient is to determine whether the bleeding symptom is truly new or if the patient has a past history of abnormal bleeding. Patients with a history of abnormal bleeding may warrant evaluation for inherited bleeding disorders, such as platelet function disorders, von Willebrand disease, hemophilia or rare factor deficiencies. Patients with no history of bleeding, for whom other causes, such as liver dysfunction, medication effect, disseminated intravascular coagulation or certain vitamin deficiencies have been ruled out may require evaluation for acquired coagulopathies, such as acquired hemophilia or acquired von Willebrand disease. Here we present three cases to discuss the diagnosis and management of the two most common acquired bleeding disorders, as well as a congenital bleeding disorder patient with a historical diagnosis.

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Section: Evaluation and Management Of Bleeding In A Patient Who Is Cr...mentioning

confidence: 99%

How I approach bleeding in hospitalized patients

Bannow

Konkle

2023

Blood

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“…The presence of coagulopathy in critically ill patients, regardless of its etiology, increases the likelihood of hemorrhage by four to fivefold and is an independent risk factor for mortality 7 . How to manage patients with coagulopathy admitted to intensive care unit (ICU) due to liver disease is controversial 8 . American Association for the Study of Liver Diseases (AASLD) and American Gastroenterological Association (AGA) recommend against the routine use of fresh frozen plasma (FFP) for minor procedures such as paracentesis to correct an elevated PT/INR in a patient with liver disease 8 – 10 .…”

Section: Introductionmentioning

confidence: 99%

“…How to manage patients with coagulopathy admitted to intensive care unit (ICU) due to liver disease is controversial 8 . American Association for the Study of Liver Diseases (AASLD) and American Gastroenterological Association (AGA) recommend against the routine use of fresh frozen plasma (FFP) for minor procedures such as paracentesis to correct an elevated PT/INR in a patient with liver disease 8 – 10 . Some studies, like Youssef et al, noted a possible failure of FFP transfusion to correct the coagulopathy in patients with liver disease 11 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of fresh frozen plasma transfusion in decompensated cirrhosis patients with coagulopathy admitted to ICU: a retrospective cohort study from MIMIC-IV database

Fu,

Yan,

Huang

et al. 2024

Sci Rep

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We aimed to explore the association between FFP transfusion and outcomes of DC patients with significant coagulopathy. A total of 693 DC patients with significant coagulopathy were analyzed with 233 patients per group after propensity score matching (PSM). Patients who received FFP transfusion were matched with those receiving conventional therapy via PSM. Regression analysis showed FFP transfusion had no benefit in 30-day (HR: 1.08, 95% CI 0.83–1.4), 90-day (HR: 1.03, 95% CI 0.80–1.31) and in-hospital(HR: 1.30, 95% CI 0.90–1.89) mortality, associated with increased risk of liver failure (OR: 3.00, 95% CI 1.78–5.07), kidney failure (OR: 1.90, 95% CI 1.13–3.18), coagulation failure (OR: 2.55, 95% CI 1.52–4.27), respiratory failure (OR: 1.76, 95% CI 1.15–2.69), and circulatory failure (OR: 2.15, 95% CI 1.27–3.64), and even associated with prolonged the LOS ICU (β: 2.61, 95% CI 1.59–3.62) and LOS hospital (β: 6.59, 95% CI 2.62–10.57). In sensitivity analysis, multivariate analysis (HR: 1.09, 95%CI 0.86, 1.38), IPTW (HR: 1.11, 95%CI 0.95–1.29) and CAPS (HR: 1.09, 95% CI 0.86–1.38) showed FFP transfusion had no beneficial effect on the 30-day mortality. Smooth curve fitting demonstrated the risk of liver failure, kidney failure and circulatory failure increased by 3%, 2% and 2% respectively, for each 1 ml/kg increase in FFP transfusion. We found there was no significant difference of CLIF-SOFA and MELD score between the two group on day 0, 3, 7, 14. Compared with the conventional group, INR, APTT, and TBIL in the FFP transfusion group significantly increased, while PaO2/FiO2 significantly decreased within 14 days. In conclusion, FFP transfusion had no beneficial effect on the 30-day, 90-day, in-hospital mortality, was associated with prolonged the LOS ICU and LOS hospital, and the increased risk of liver failure, kidney failure, coagulation failure, respiratory failure and circulatory failure events. However, large, multi-center, randomized controlled trials, prospective cohort studies and external validation are still needed to verify the efficacy of FFP transfusion in the future.

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How to manage hemostasis in patients with liver disease during interventions

Roberts

2023

Hematology

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Patients with advanced chronic liver disease (CLD) often need procedures to both treat and prevent complications of portal hypertension such as ascites or gastrointestinal bleeding. Abnormal results for hemostatic tests, such as prolonged prothrombin time, international normalized ratio, and/or thrombocytopenia, are commonly encountered, raising concerns about increased bleeding risk and leading to transfusion to attempt to correct prior to interventions. However hemostatic markers are poor predictors of bleeding risk in CLD, and routine correction, particularly with fresh frozen plasma and routine platelet transfusions, should be avoided. This narrative review discusses the hemostatic management of patients with CLD using 2 case descriptions.

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Prophylactic fresh frozen plasma versus prothrombin complex concentrate for preprocedural management of the coagulopathy of liver disease: A systematic review

Cited by 3 publications

References 43 publications

How I approach bleeding in hospitalized patients

How I approach bleeding in hospitalized patients

Efficacy of fresh frozen plasma transfusion in decompensated cirrhosis patients with coagulopathy admitted to ICU: a retrospective cohort study from MIMIC-IV database

How to manage hemostasis in patients with liver disease during interventions

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