Controversies in the use of fresh frozen plasma in critically ill small animal patients

Beer, Kari Santoro; Silverstein, Deborah C.

doi:10.1111/vec.12280

Cited by 27 publications

(27 citation statements)

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“…1 It is used extensively in human medicine with multiple published guidelines. [2][3][4] These guidelines typically recommend administration of FFP for patients with acquired coagulopathies in the presence of active hemorrhage. Examples of such acquired coagulopathies in people include massive transfusion, disseminated intravascular coagulopathy (DIC), liver failure, vitamin K antagonism, and thrombotic thrombocytopenic purpura.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 Coagulopathy is the most common indication, which is consistent with human guidelines. 4 FFP is not indicated for hypoalbuminemia and hypovolemia in multiple human guidelines, 2 which has led to a decrease in veterinary use for these indications. 11 FFP use in cats has been previously reported in subsets of the data of 2 retrospective studies for a total of 38 cats.…”

Section: Introductionmentioning

confidence: 99%

“…10,17 In dogs, the incidence of FFP ATR is not as well described. 4 A study including 283 dogs reported an ATR rate of 1%. 11 Additionally, a recent study in dogs that included 412 FFP transfu-sions reported an ATR rate of 8%, which was lower than packed RBCs (pRBCs) (17%) and whole blood (15%).…”

Section: Introductionmentioning

confidence: 99%

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Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009–2016

Lane

Sinnott‐Stutzman

2020

J Vet Emergen Crit Care

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Objectives To document indications for fresh frozen plasma (FFP) use in cats, doses administered, and frequency of adverse transfusion reactions (ATR). Design Retrospective observational study from January 2009 to November 2016. Setting Large urban referral and emergency facility. Animals One hundred twenty‐one client‐owned cats that received FFP. Interventions None. Measurements and Main Results Signalment, indication(s), dose, pre‐ and posttransfusion total plasma protein, prothrombin time, activated partial thromboplastin time, as well as possible ATR, primary disease process, and outcome were recorded. Doppler blood pressure was increased posttransfusion (mean pre 99.5 ± 30.8 mm Hg; post 108.5 ± 32.5 mm Hg, P = .027). Cats were significantly less likely to be coagulopathic posttransfusion (P < 0.001). Most common indications were suspected coagulopathy (n = 105, 83%), hemorrhage (n = 45, 35%), and hypotension (n = 32, 25%). Median dose was 6 mL/kg (interquartile range = 3 mL/kg) and was negatively correlated with body weight (r = –.598, P < 0.001). Possible ATR occurred in 17 of 108 (16%, 95% confidence interval [CI], 10–24%) of transfusions. Increased body temperature was most common in 11 of 108 (10%, 95% CI, 5–18%), followed by tachypnea/dyspnea in 8 of 108 (7%, 95% CI, 3–13%). Common primary disease processes included liver disease (n = 41, 34%), neoplasia (n = 19, 16%), and sepsis (n = 15, 12%). Overall mortality was 54%. Improvement of clotting times was associated with increased odds of survival (odds ratio = 2.4; 95% CI, 1.1–5.3; P = 0.023). Conclusions Clinician justifications for FFP transfusions are comparable to that reported in dogs; however, the mL/kg dose is lower. Coagulopathy and blood pressure significantly improve posttransfusion. Possible ATR were as frequent as that reported with feline packed RBCs transfusions and classified as mild.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009–2016

Lane

Sinnott‐Stutzman

2020

J Vet Emergen Crit Care

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“…A large retrospective study of dogs and cats undergoing ultrasound‐guided biopsies found that prolongation of activated partial thromboplastin time (aPTT) was a risk factor for bleeding complications in cats, and prolongation of prothrombin time (PT) was a risk factor in dogs, though the numbers of animals experiencing complications even among those with prolonged times was relatively small . Literature suggests that abnormal coagulation test results do not correlate well with clinical bleeding in people, and that evidence supporting a predictable relationship in veterinary medicine is lacking . Thus, further research is needed to generate best practices in veterinary medicine.…”

Section: Introductionmentioning

confidence: 99%

Performance characteristics of the turbidimetric ACL‐TOP CTS 300 coagulation analyzer in dogs and cats

Sharkey

Little

Williams

et al. 2018

J Vet Emergen Crit Care

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The turbidimetric system had a slight high proportional positive bias compared with mechanical clot detection. Thus, new reference intervals were generated including for novel parameters generated by clot curve analysis. Some preanalytical errors can be identified by inspection of clot curves. This robust novel technology compares favorably with mechanical endpoint detection methods and can be used in dogs and cats.

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“…The PT was notably prolonged – 9∙2 and 10∙9 seconds (reference interval 6∙0 to 7∙5 seconds) – in two samples in the DPT group although statistical differences were not detected among the various thawing methods for the measurement of PT. In one of these samples, PTT and factor VII were within normal limits, making a sample collection or handling artefact the most likely cause of the abnormal PT (Smith , Beer & Silverstein , Susan & Rousseau ). In the second sample, both PT and PTT were <25% above outside the reference interval and not considered clinically important.…”

Section: Discussionmentioning

confidence: 99%