Dose-associated Pulmonary Complication Rates after Fresh Frozen Plasma Administration for Warfarin Reversal.
J Thromb Haemost. 2015 Dec 8;
Authors: Marshall A, Levine M, Howell ML, Chang Y, Riklin E, Parry BA, Callahan RT, Okechukwu I, Ayres AM, Nahed BV, Goldstein JN
Abstract
BACKGROUND: Fresh frozen plasma (FFP) is often administered to reverse warfarin anticoagulation. Administration has been associated with pulmonary complications but it is unclear whether this risk is dose-related.
AIMS: We sought to characterize the incidence and dose relationship of pulmonary complications including transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) after FFP administration for warfarin reversal.
METHODS: We performed a structured retrospective review of patients who received FFP for warfarin reversal in the emergency department (ED) of an academic tertiary care hospital over a 3-year period. Logistic regression was used to explore the relationship between FFP dose and risk of pulmonary events.
RESULTS: 251 patients met inclusion criteria. Overall, 49 patients (20%) developed pulmonary complications including 30 (12%) TACO, 2 (1%) TRALI, and 17 (7%) pulmonary edema not meeting criteria for TACO. Pulmonary complications were significantly more frequent in those who received >3 units of FFP (34.0% versus 15.6%, p=0.006). Stratified by subtype of complication, only the risk of TACO was statistically significant (28.3% versus 7.6%, p=0.0002). In multivariable analysis controlling for age, sex, initial systolic blood pressure (SBP) and intravenous fluids given in the ED, >3 units of FFP remained a significant risk factor for pulmonary complications (OR=2.49, 95% CI 1.21-5.13, p=0.01).
CONCLUSIONS: Almost 20% of patients who received FFP for warfarin reversal developed pulmonary complications, primarily TACO, and this risk increased with >3 units of FFP. Clinicians should be aware of and prepared to manage these complications. This article is protected by copyright. All rights reserved.
PMID: 26644327 [PubMed - as supplied by publisher]