Is fresh‐frozen plasma clinically effective? An update of a systematic review of randomized controlled trials (CME)

Yang, Lucy; Stanworth, Simon; Hopewell, Sally; Dorée, Carolyn; Murphy, Mike

doi:10.1111/j.1537-2995.2011.03515.x

Cited by 246 publications

(209 citation statements)

References 53 publications

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“…A systematic review of all randomised controlled trials evaluating the clinical use of FFP found no consistent clinical benefit across a range of clinical groups. 8 Meta-analysis of trials in the cardiac section showed no significant difference between the experimental and control arms for the outcome of blood loss (-35.24 ml; 95% confidence interval -84.16-13.68 ml).…”

Section: Will Ffp Improve Clinical Outcomes?mentioning

confidence: 99%

Uses and abuses of fresh-frozen plasma for the prophylaxis of bleeding

Desborough

Stanworth

2013

Clinical Medicine

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Section: Will Ffp Improve Clinical Outcomes?mentioning

confidence: 99%

Uses and abuses of fresh-frozen plasma for the prophylaxis of bleeding

Desborough

Stanworth

2013

Clinical Medicine

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“…Approximately, 280 000 units of FFP are issued annually in the UK to adults (93%) and children (7%) [51]. A recent systematic review found no evidence of benefit for prophylactic or therapeutic FFP use across a range of settings -including use in liver disease, cardiac surgery, warfarin anticoagulation reversal, thrombotic thrombocytopenic purpura, burns, shock and head injury [52]. However, despite 80 randomised controlled trials on this topic, the methodological quality of many trials is poor [52].…”

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confidence: 99%

“…A recent systematic review found no evidence of benefit for prophylactic or therapeutic FFP use across a range of settings -including use in liver disease, cardiac surgery, warfarin anticoagulation reversal, thrombotic thrombocytopenic purpura, burns, shock and head injury [52]. However, despite 80 randomised controlled trials on this topic, the methodological quality of many trials is poor [52]. A large observational study of coagulopathy in ICU (ISOC-1) [53] illustrates the clinical uncertainties surrounding the use of FFP.…”

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confidence: 99%

Evidence and triggers for the transfusion of blood and blood products

2014

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SummaryAllogeneic red cell transfusion is a commonly used treatment to improve the oxygen carrying capacity of blood during the peri-operative period. Increasing arterial oxygen content by increasing haemoglobin does not necessarily increase tissue oxygen delivery or uptake. Although the evidence-base for red cell transfusion practice is incomplete, randomised studies across a range of clinical settings, including surgery, consistently support the restrictive use of red cells, with no evidence of benefit for maintaining patients at higher haemoglobin thresholds (liberal strategy). A recent meta-analysis of 7593 patients concluded that a restrictive transfusion strategy was associated with a reduced risk of healthcare-associated infections (pneumonia, mediastinitis, wound infection, sepsis) when compared with a liberal transfusion strategy. The degree to which the optimal haemoglobin concentration or transfusion trigger should be modified for patients with additional specific risk factors (e.g. ischaemic heart disease), remains less clear and requires further research. Although most clinical practice guidelines recommend restrictive use of red cells, and many blood transfusion services have seen marked falls in overall usage of red cells, the use of other blood components such as fresh frozen plasma, platelets, and cryoprecipitate has risen. In clinical practice, administration of fresh frozen plasma is usually guided by laboratory tests of coagulation, mainly prothrombin time, international normalised ratio and activated partial thromboplastin time, but the predictive value of these tests to predict bleeding is poor.

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“…According to the results of a systematic review of 80 randomized clinical trials, the current guidelines for the administration of FFP are largely empirical. 21 In the United States, FFP at a dose of 10 to 15 mL/kg is used to reverse the warfarin effect; however, there is a paucity of evidence supporting its efficacy. 22 Moreover, FFP transfusion has several disadvantages, that is, (1) a delay in therapeutic effect because of the time required to obtain the ABO blood type and to thaw and transfuse several hundred milliliters of FFP; (2) transfusionassociated circulatory overload, especially in elderly patients with cardiac disease; (3) allergic reactions; (4) infection from exposure to multiple donors; and (5) transfusion-related acute lung injury, the most common cause of transfusionrelated deaths in the United States.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Fresh Frozen Plasma Infusion is Ineffective in Reversing Warfarin Anticoagulation and Preventing Delayed Intracranial Hemorrhage After Falls

Reddy

Sharma

Grotts

et al. 2015

The Neurohospitalist

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Background: Elderly patients, with considerable fall risk, are increasingly anticoagulated to prevent thromboembolic disease. We hypothesized that a policy of prophylactic fresh frozen plasma (FFP) infusion in patients having falls would reverse vitamin K antagonists (VKAs) and that reversal would decrease delayed intracranial hemorrhage (ICH). Methods: A retrospective review of patients with trauma admitted to a level 2 community trauma center was performed from January 2010 until November 2012. Inclusion criteria were: ground level fall (GLF) with suspected head trauma, on VKA, an international normalized ratio (INR) of >1.5, and a negative head computed tomography (CT). Patients were transfused with FFP to a goal INR of <1.5 while observed. Patients were classified as reversed (REV) if the lowest INR achieved within 4 to 24 hours after initial INR was <1.5 or unreversed (NREV) if lowest INR achieved was >1.5. Chi-square and logistic regression were performed. Results: A total of 194 patients met the criteria. In all, 43 (22%) patients were able to be REV, and 151 (78%) patients remained NREV. Unreversed patients were male and younger (P < .05). There was no difference in mean FFP received. Unreversed patients had a higher initial INR of 3.0 compared to REV patients (2.5; P ¼ .018). One patient developed a delayed ICH and belonged to the REV group. Conclusion: The incidence of delayed hemorrhage was 0.5%. A strategy of prophylactic FFP infusion was ineffective in VKA reversal. We recommend against prophylactic infusion of FFP during a period of observation for patients on VKA with suspected head trauma and a negative initial CT.

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Is fresh‐frozen plasma clinically effective? An update of a systematic review of randomized controlled trials (CME)

Cited by 246 publications

References 53 publications

Uses and abuses of fresh-frozen plasma for the prophylaxis of bleeding

Uses and abuses of fresh-frozen plasma for the prophylaxis of bleeding

Evidence and triggers for the transfusion of blood and blood products

Prophylactic Fresh Frozen Plasma Infusion is Ineffective in Reversing Warfarin Anticoagulation and Preventing Delayed Intracranial Hemorrhage After Falls

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