Transfusion of fresh‐frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial (CME)

Müller, Marcella C.A.; Arbous, M. Sesmu; Man, Angélique M. E. de; Vink, Roel; Karakus, A; Straat, Marleen; Binnekade, Jan M.; Jonge, Evert de; Vroom, Margreeth B.; Juffermans, Nicole P.

doi:10.1111/trf.12750

Cited by 105 publications

(119 citation statements)

References 48 publications

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“…The transfusion of FFP in non-bleeding ICU patients (TOPIC) trial was designed to see whether prophylactic FFP transfusions could be safely omitted. 4 No difference between bleeding in patients given FFP prophylactically and the control group was seen, although the trial closed early due to slow recruitment and did not reach significance for non-inferiority.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Laboratory indices of clotting correct in only a small proportion of patients following FFP administration and there have been few studies looking at whether prophylactic FFP mitigates bleeding risk. 4 This is of significance as FFP transfusion is associated with risks such as transfusion-related acute lung injury, transfusion associated circulatory overload and anaphylactic reactions. 5 Whilst there is greater consensus over platelet transfusion thresholds prior to invasive procedures, 6 there is still inconsistency in the thresholds used in clinical practice and in the dose that is administered.…”

Section: Introductionmentioning

confidence: 99%

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Peri-procedural management of bleeding risks in critical care patients: A local audit and national survey

Hibbs

McKechnie

Little

et al. 2014

Journal of the Intensive Care Society

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Estimation of bleeding risk in critical care patients undergoing interventional radiological procedures is frequently made on the basis of blood tests. If these tests are abnormal, fresh frozen plasma and/or platelet transfusions may be given to reduce the risk of bleeding. We performed an audit and national survey of the use of fresh frozen plasma and platelet transfusions prior to interventional radiological procedures. We identified 68 consecutive chest, abdominal or pelvic drain insertions in 54 critical care patients between 2008 and 2011 at a single intensive care unit. Eight (12.3%) patients were transfused fresh frozen plasma prior to drain insertion despite having a prothrombin time below 22 s. One patient with a prothrombin time above this threshold received fresh frozen plasma. One patient received a platelet transfusion, at double dose, despite a platelet count above 50 Â 10 9 /l. A national survey of interventional radiologists demonstrated extensive variability in safe thresholds for invasive procedures and usage of fresh frozen plasma. There is a need for further clarification around coagulopathy and interventional radiology in the critical care setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Peri-procedural management of bleeding risks in critical care patients: A local audit and national survey

Hibbs

McKechnie

Little

et al. 2014

Journal of the Intensive Care Society

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“…2. FFP-12 ml/kg body weight was given perioperatively to all patients taking oral anticoagulant drugs irrespective of INR levels (based on the standard dose protocol) [6][7][8]. 3.…”

Section: Methodsmentioning

confidence: 99%

SDH with Bleeding Diathesis—a Management Protocol

et al. 2015

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Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I-patients on antiplatelets, group II-patients on oral anticoagulants, and group III-patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

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“…Fresh frozen plasma is frequently used as prophylaxis to correct coagulopathy before CVC insertion. However, there is little evidence that FFP prevents bleeding [22], and CVC insertion is probably safe in modest derangements of the PT/aPTT [23][24][25][26]. A recently published, prospective, non-inferiority trial specifically addressed this issue.…”

Section: Fresh Frozen Plasmamentioning

confidence: 99%

“…There was no difference in the rates of bleeding or lung injury between either the groups. The INR was only reduced to less than 1.5 in 54% of the patients transfused FFP [22]. The study is limited by its small size, only 80 patients being enrolled, and patients with thrombocytopenia were not studied.…”

Section: Fresh Frozen Plasmamentioning

confidence: 99%

The management of abnormal haemostasis in the ICU

Retter

Barrett

2014

Anaesthesia

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SummaryThe aetiology and management of haemostatic abnormalities in critical care patients are considered in this narrative review. The mechanisms of normal haemostasis and derangements that occur as a result of sepsis and organ dysfunction are discussed. Finally, the management of haemostatic abnormalities as they relate to critical care practice are considered, including the management of heparin‐induced thrombocytopenia.

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Transfusion of fresh‐frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial (CME)

Abstract: In critically ill patients undergoing an invasive procedure, no difference in bleeding complications was found regardless whether FFP was prophylactically administered or not.

Cited by 105 publications

References 48 publications

Peri-procedural management of bleeding risks in critical care patients: A local audit and national survey

Peri-procedural management of bleeding risks in critical care patients: A local audit and national survey

SDH with Bleeding Diathesis—a Management Protocol

The management of abnormal haemostasis in the ICU

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