Multicentre clinical trial of low volume fresh frozen plasma therapy in acute pancreatitis

Leese, T; Holliday, Mark; Heath, Dugal; Hall, A. W.; Bell, P. R.

doi:10.1002/bjs.1800741012

Cited by 92 publications

(46 citation statements)

References 14 publications

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“…PE is an extracorporeal technique that removes toxins, metabolites, inflammatory factors and toxic mediators from the plasma (14)(15)(16)(17) and it is hypothesized that removal of these factors can be therapeutic in certain situations. We …”

Section: Introductionmentioning

confidence: 99%

Severe acute arsine poisoning treated by plasma exchange

Song¹,

Wang²,

Li³

et al. 2007

Clinical Toxicology

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Section: Introductionmentioning

confidence: 99%

Severe acute arsine poisoning treated by plasma exchange

Song¹,

Wang²,

Li³

et al. 2007

Clinical Toxicology

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“…However, placebo group to 6.2% (13/207) in the patient population receiving somatostatin. protease inhibitors (like aprotinin, gabexate mesylate) and hormones (like glucagon and somatostatin) have been A phase I-II study [38] of patients with moderate to severe acute pancreatitis treated with three different doses investigated in human acute pancreatitis without success [4,[12][13][14][15].…”

mentioning

confidence: 99%

The Role of Octreotide and Somatostatin in Acute and Chronic Pancreatitis

et al. 1999

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Acute pancreatitis may follow a mild or a severe course. Whereas mild or edematous pancreatitis is a self-limiting disease with a low complication rate and low death rate, morbidity and mortality in severe or necrotizing pancreatitis are still unacceptably high. The major problem is the lack of a specific drug, especially in the early phase of the disease, to interfere with the systemic inflammatory response syndrome and to limit or prevent complications of the disease. Although the initiating pathophysiological process is not known, the destruction of the gland (‘autodigestion’) by digestive enzymes may be responsible for disease progression. Inhibition of pancreatic activity, which reduces exocrine secretion and further prevents the release and activation of enzymes, was therefore suggested as a specific treatment concept. The results of clinical investigations using somatostatin or its analogue are controversial, since all these trials had low statistical power. In a recent multicenter randomized controlled study with a large number of patients (n = 302) (and an adequate level of disease severity), no benefit of octreotide on progression or outcome was found. Chronic pancreatitis is characterized by an irreversible destruction of the exocrine and endocrine pancreatic parenchyma leading to maldigestion and diabetes. Pain, which may be caused by increased ductal pressure, is one of the most dominant symptoms in chronic pancreatitis. However, no beneficial effects on pain with pancreatic exocrine secretion-inhibiting drugs have been demonstrated. Treatment of other complications of the disease (pseudocyst formation, fistula and pancreatic ascites), with somatostatin or octreotide has given conflicting results. However, in a prophylactic clinical setting (e.g. elective pancreatic surgery) the inhibition of exocrine pancreatic secretion reduces complications.

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“…Of note, the study did not include measurement of coagulation tests. In the other trial, the effectiveness of FP was evaluated in patients with acute pancreatitis, 22,24 and 275 patients (in total) were randomized to receive either FP or a colloid solution, again with no evidence of benefit for plasma.…”

Section: Evidence For and Against The Effectiveness Of Fpmentioning

confidence: 99%

The Evidence-Based Use of FFP and Cryoprecipitate for Abnormalities of Coagulation Tests and Clinical Coagulopathy

2007

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There continues to be a general but unfounded enthusiasm for fresh frozen plasma (FFP) or frozen plasma (FP) usage across a range of clinical specialties in hospital practice. Plasma for transfusion is most often used where there are abnormal coagulation screening tests, either therapeutically in the face of bleeding, or prophylactically in nonbleeding patients prior to invasive procedures or surgery. Little evidence exists to inform best therapeutic transfusion practice, and most studies describe plasma use in a prophylactic setting. Laboratory abnormalities of coagulation are considered by many clinicians to be a predictive risk factor for bleeding prior to invasive procedures or in other clinical situations where bleeding risk exists, and plasma for transfusion is presumed to improve the laboratory results and reduce this risk. However, most guideline indications for the prophylactic use of plasma for transfusion are not supported by evidence from good-quality randomized trials. Arguably, the strongest randomized controlled trial (RCT) evidence indicates that prophylactic plasma for transfusion is not effective across a range of different clinical settings, and this is supported by data from nonrandomized studies in patients with mild to moderate abnormalities in coagulation tests. There is a need to undertake new trials evaluating the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients, to understand whether the presumed benefits outweigh the real risks. In addition, new hemostatic tests that better define the risk of bleeding and monitor the effectiveness of the use of FFP should be validated. Last, there is an opportunity to develop effective educational strategies aimed at addressing understanding and compliance with recommendations in guidelines. What Is Plasma for Transfusion?Frozen plasma (FP) is human donor plasma, either recovered from a single whole-blood donation or obtained by plasmapheresis, frozen within a specific time period after collection and then stored at a defined temperature, typically -30°C. Plasma frozen within 8 hours is called fresh frozen plasma (FFP); plasma frozen at slightly longer intervals (typically up to 24 hours) after collection is referred to as frozen plasma (known as F24 in the U.S.). Levels of the labile coagulation factors V and VIII may be slightly lower in FP in comparison with FFP. Although both components (FFP and F24) are largely considered clinically equivalent by physicians, and for the purposes of this review will be covered (interchangeably) by the common term FP, evidence for equivalence has not been documented. After thawing, FP contains near-normal levels of most plasma proteins, including procoagulant and inhibitory components of the coagulation system, acute phase proteins, immunoglobulins and albumin, although all levels are diluted by the citrate anticoagulant solution. Factor VIII (FVIII) is typically the only plasma protein whose level is quality controlled in the specification of the product, and as required by UK 1 an...

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Multicentre clinical trial of low volume fresh frozen plasma therapy in acute pancreatitis

Cited by 92 publications

References 14 publications

Severe acute arsine poisoning treated by plasma exchange

Severe acute arsine poisoning treated by plasma exchange

The Role of Octreotide and Somatostatin in Acute and Chronic Pancreatitis

The Evidence-Based Use of FFP and Cryoprecipitate for Abnormalities of Coagulation Tests and Clinical Coagulopathy

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