Role of Fresh Frozen Plasma Infusion in Correction of Coagulopathy of Chronic Liver Disease: A Dual Phase Study

Youssef, Wael I; Salazar, Fernando; Dasarathy, Srinivasan; Beddow, Timothy; Mullen, Kevin Daniel

doi:10.1111/j.1572-0241.2003.07467.x

Cited by 170 publications

(47 citation statements)

References 20 publications

(20 reference statements)

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“…During massive blood transfusion, FFP administration was advised at a ratio of 1:2 with red cells infusion, to avoid dilution of coagulation factors [144]. In patients with INR > 1.5, FFP was administered at a dosage of 12-15 mL/kg before liver biopsy, but evidence was not provided on whether or not this practice improved clinical outcomes [146]. In two studies this regimen allowed correction of PT in only 20% of patients receiving 900 mL of FFP [145,146].…”

Section: Fresh Frozen Plasmamentioning

confidence: 99%

“…In patients with INR > 1.5, FFP was administered at a dosage of 12-15 mL/kg before liver biopsy, but evidence was not provided on whether or not this practice improved clinical outcomes [146]. In two studies this regimen allowed correction of PT in only 20% of patients receiving 900 mL of FFP [145,146]. The infusion of <500 mL of FFP seldom corrects the PT by more than 2-3 s [142,147].…”

Section: Fresh Frozen Plasmamentioning

confidence: 99%

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Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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Section: Fresh Frozen Plasmamentioning

confidence: 99%

Section: Fresh Frozen Plasmamentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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“…Variceal bleeding in cirrhosis carries a mortality of 7–15% [25]. The use of fresh frozen plasma (FFP) in patients with cirrhosis and portal hypertension has been shown to increase portal pressures in a linear fashion based upon volume [26]. A study by Youssef points out that increased doses of FFP are often required to improve coagulopathy in chronic liver disease patients who were unresponsive to vitamin K therapy, highlighting that six units were associated with greater correction than compared to those receiving less than six units – a significant amount of volume [27].…”

Section: Discussionmentioning

confidence: 99%

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Laubham

Kallwitz

2018

Journal of Community Hospital Internal Medicine Perspectives

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Synthetic dysfunction observed in cirrhosis results in altered production of procoagulants and anticoagulants that can lead to both bleeding and thrombotic events, respectively. In patients with decompensated cirrhosis, frequent hospital visits often require bedside procedures such as diagnostic paracenteses, thoracenteses and endoscopy. It can be difficult to determine at what coagulation threshold procedures can safely be performed. Currently, the most common therapies given pre-procedurally include fresh frozen plasma (FFP) and vitamin K. The effectiveness of these treatments is estimated by international normalized ratio (INR), an imprecise measure of coagulation in the setting of cirrhosis. Transfusion with FFP may lead to detrimental side effects, including worsening volume overload and increased portal hypertension. We present a case of a 60-year-old patient intubated for acute hypoxic respiratory failure secondary to volume overload who subsequently developed bilateral pneumothoraces, requiring immediate chest tube placement. In this case, the patient had ongoing hepatic decompensation with volume overload and acute worsening of coagulopathy with an INR of 4.2. In this setting, 4-Factor Prothrombin Complex Concentrate (4F-PCC) was chosen to correct coagulation parameters with a low infusion volume. One hour following administration, INR was 1.5. Chest tubes were placed bilaterally and oxygenation improved without bleeding complications. While the data is still lacking, 4F-PCC may be considered for urgent and emergency situations in cirrhotic patients.

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“…Youssef et al reported on FFP transfusions in 100 adult patients with liver disease, and found that it was difficult to correct abnormalities unless large volumes of FFP (6 units) were infused and the correction was short-lived. 52 The prophylactic administration of FFP has not been shown to decrease the risk of bleeding or to improve outcome. 53 Auzinger et al showed that percutaneous tracheostomy in patients with liver disease and resistant coagulopathy in whom the INR could not be lowered to Ͻ 1.6 or the platelets increased to Ͼ 50 000 cells/dL was not accompanied by a higher bleeding rate than in patients in whom the INR and/or platelet count could be corrected before the procedure.…”

Section: Ffpmentioning

confidence: 99%

Bleeding and Clotting Disorders in Pediatric Liver Disease

Wicklund

2011

Hematology

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The coagulopathy of liver disease in pediatric patients presents an unusual set of challenges. Little pediatric data have been published, so this review is based largely on adult studies. There is a precarious balance between deficiencies of clotting factors and anticoagulation factors in liver disease that result in abnormal prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests that would suggest a bleeding tendency, yet the patients can form a clot and are at risk of thromboembolic disease. Attention has centered on thromboelastography and thrombin-generation assays to clarify the patient's ability to control bleeding, but these tests are not routinely available to many treating physicians.

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Role of Fresh Frozen Plasma Infusion in Correction of Coagulopathy of Chronic Liver Disease: A Dual Phase Study

Cited by 170 publications

References 20 publications

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Bleeding and Clotting Disorders in Pediatric Liver Disease

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