Prophylactic plasma transfusion for patients without inherited bleeding disorders or anticoagulant use undergoing non-cardiac surgery or invasive procedures

Huber, Jonathan; Stanworth, Simon; Dorée, Carolyn; Fortin, P; Trivella, Marialena; Brunskill, Susan J; Hopewell, Sally; Wilkinson, Kirstin; Estcourt, Lise J

doi:10.1002/14651858.cd012745.pub2

Cited by 14 publications

(26 citation statements)

References 111 publications

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“…[139][140][141][142][143][144][145] A recent Cochrane review concluded that there is uncertainty about the utility and safety of prophylactic FFP use. 146 Thus, use of FFP is rarely indicated.…”

Section: Coagulation Testingmentioning

confidence: 99%

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Neuberger

Patel

Caldwell

et al. 2020

Gut

233

201

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Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.

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Section: Coagulation Testingmentioning

confidence: 99%

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Neuberger

Patel

Caldwell

et al. 2020

Gut

233

201

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show abstract

“…The clinical significance of a spontaneously increased PT-INR in a non-bleeding critical care patient is unclear [ 25 ]. Further, many patients with a spontaneously increased PT-INR receive prophylactic treatment with plasma before an invasive procedure, but with low evidence [ 5 , 6 ]. Even though PT-INR can be normalized, the haemostatic balance measured with thrombin generation and thromboelastography is usually not normalized [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the current evidence is limited regarding the effect of intravenous vitamin K on standard coagulation assays in critically ill patients, and it is not clear which dose and administration interval should be used. Furthermore, patients with mild coagulopathy are often given prophylactic plasma before invasive procedures albeit low evidence and risks associated with transfusion [ 5 , 6 ]. Vitamin K might be a preferable option in this setting.…”

Section: Introductionmentioning

confidence: 99%

The effect of vitamin K on prothrombin time in critically ill patients: an observational registry study

2021

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Background Previous studies have indicated that vitamin K deficiency is common in non-bleeding critically ill patients with slightly prolonged prothrombin time-international normalized ratio (PT-INR). It has never been investigated thoroughly whether the administration of vitamin K to these patients could affect their PT-INR. Therefore, the aim of this registry study was to evaluate changes in PT-INR in response to vitamin K in critically ill patients with PT-INR in the range of 1.3–1.9. Methods Patients admitted to a mixed 9-bed general intensive care unit at a University Hospital, between 2013 and 2019 (n = 4541) with a PT-INR between 1.3 and 1.9 at any time during the stay were identified. Patients who received vitamin K with appropriate sampling times for PT-INR and without exclusion criteria were matched with propensity score to patients from the same cohort who did not receive vitamin K (controls). PT-INR was measured at admission, within 12 h before vitamin K administration and 12–36 h following vitamin K administration. Exclusion criteria included pre-existing liver cirrhosis, any plasma or platelet transfusion, or > 1 unit red blood cell transfusion between PT-INR samplings. Results Propensity score matching resulted in two groups of patients with 129 patients in each group. PT-INR decreased in both groups (1.4 [1.3–1.4] in the vitamin K group and 1.4 [1.3–1.6] in the controls, p < 0.001 and p = 0.004, respectively). The decrease in PT-INR was slightly more pronounced in patients who received vitamin K (delta PT-INR − 0.10 [− 0.30 to − 0.10] in the vitamin K group and − 0.10 [− 0.20 to 0.10] in the controls, p = 0.01). Conclusion In critically ill patients with a PT-INR of 1.3–1.9, the administration of vitamin K resulted in a slightly larger decrease of PT-INR 12–36 h after administration compared to controls. Future studies should focus on identifying which patient populations may benefit most from vitamin K administration as well as whether vitamin K could be a better alternative than plasma or prothrombin complex concentrate to improve PT-INR before non-emergent invasive procedures.

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“…More important, FFP can lead to circulating volume overload, which may increase bleeding risk by increasing portal and central venous pressure. Given the poor evidence that FFP is clinically effective in prophylactic and treatment settings, 23,24 a search for alternative prohemostatic options would be wise. Our data suggest PCCs to be effective in improving hemostatic capacity during HPB surgery, although the exaggerated responses in our in vitro test may warrant careful dosing.…”

Section: Discussionmentioning

confidence: 99%

“…More important, FFP can lead to circulating volume overload, which may increase bleeding risk by increasing portal and central venous pressure. Given the poor evidence that FFP is clinically effective in prophylactic and treatment settings,23,24 a search for alternative prohemostatic options would be wise. Our data F I G U R E 5 Absolute ETP levels from thrombomodulin modified thrombin generation testing in plasma of controls, and patients after PPPD before (−) and after (+) in vitro addition of prohemostatic agents.…”

mentioning

confidence: 99%

Efficacy of pro‐ and anticoagulant strategies in plasma of patients undergoing hepatobiliary surgery

Bos

Boom

et al. 2020

Journal of Thrombosis and Haemostasis

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Prophylactic plasma transfusion for patients without inherited bleeding disorders or anticoagulant use undergoing non-cardiac surgery or invasive procedures

Cited by 14 publications

References 111 publications

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

The effect of vitamin K on prothrombin time in critically ill patients: an observational registry study

Efficacy of pro‐ and anticoagulant strategies in plasma of patients undergoing hepatobiliary surgery

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