A national study of plasma use in critical care: clinical indications, dose, and effect on prothrombin time.
Crit Care. 2011 Apr 5;15(2):R108
Authors: Stanworth SJ, Walsh TS, Prescott RJ, Lee RJ, Watson DM, Wyncoll D, Intensive Care Study Of Coagulopathy Isoc Investigators T
ABSTRACT: INTRODUCTION: Fresh frozen plasma (FFP) is widely used, but few studies have described patterns of plasma use in critical care. We carried out a multicentre study of coagulopathy in intensive care units (ICUs) and described overall FFP utilisation in adult critical care, the indications for transfusions, factors indicating the doses used, and the effects of plasma on coagulation. METHODS: A prospective multicentre observational study of all sequentially admitted patients to 29 adult UK general ICUs over 8 weeks. Daily data throughout ICU admission were collected concerning coagulation, relevant clinical outcomes (including bleeding), coagulopathy (defined as International Normalised Ratio, INR >1.5, or equivalent prothrombin time, PT), FFP and cryoprecipitate use, and indications for transfusion. RESULTS: Of 1923 admissions, 12.7% received FFP in the ICU during 404 FFP treatment episodes (1212 FFP units). Overall, 0.63 FFP units per ICU admission were transfused (0.11 units per ICU day). Reasons for FFP transfusion were: bleeding (48%), pre-procedural prophylaxis (15%), and prophylaxis without planned procedure (36%). Overall, median FFP dose was 10.8 ml.kg-1, but varied widely (1st, 3rd quartile 7.2, 14.4 ml.kg-1). 31% of FFP treatments were to patients without PT prolongation, and 41% were to patients without recorded bleeding and only mildly deranged INR (<2.5). Higher volumes of FFP were administered when the indication was bleeding (median dose: bleeding 11.1 mL.kg-1, pre-procedural prophylaxis 9.8 mL.kg-1, prophylaxis without procedure 8.9 mL.kg-1; P=0.009 across groups) and when the pre-transfusion INR was higher (ranging from median dose 8.9 mL.kg-1 when INR [less than or equal to]1.5, to 15.7 mL.kg-1 at INR >3; P<0.001 across ranges). Regression analyses suggested bleeding was the strongest predictor of higher FFP dose. Pre-transfusion INR was more frequently normal when the transfusion indication was bleeding. Overall, post transfusion corrections of INR were consistently small unless the pre-transfusion INR was >2.5, but administration during bleeding was associated with greater INR corrections. CONCLUSIONS: There is wide variation in FFP use by ICU clinicians and a high proportion of current FFP transfusions are of unproven clinical benefit. Better evidence from clinical trials could significantly alter patterns of use and modify current treatment costs.
PMID: 21466676 [PubMed - as supplied by publisher]