Fresh frozen plasma transfusion in critically ill medical patients with coagulopathy*
| Autor: | Bekele Afessa, Saqib I. Dara, Ognjen Gajic, S. Breanndan Moore, Rimki Rana |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Male
medicine.medical_specialty Gastrointestinal bleeding Critical Care Lung injury Critical Care and Intensive Care Medicine law.invention Plasma law Intensive care Severity of illness medicine Coagulopathy Humans International Normalized Ratio Intensive care medicine APACHE Aged Retrospective Studies business.industry Retrospective cohort study Disseminated Intravascular Coagulation Middle Aged medicine.disease Intensive care unit Intensive Care Units Emergency medicine Female Fresh frozen plasma business |
| Zdroj: | Critical Care Medicine. 33:2667-2671 |
| ISSN: | 0090-3493 |
| Popis: | Objective: Although restrictive red cell transfusion practice has become a standard of care in the critically ill, data on the use of fresh frozen plasma (FFP) are limited. We hypothesized that the practice of FFP transfusion in the medical intensive care unit is variable and that liberal use may not be associated with improved outcome. Design: Retrospective cohort study. Setting: A 24-bed medical intensive care unit in a tertiary referral center. Patients: All patients admitted to a medical intensive care unit duringa 5-month period who had abnormal coag ulation defined as international normalized ratio (INR) of >1.5-times normal. Interventions: None. Measurements and Main Results: We collected data on demographics, severity of illness as measured by Acute Physiology and Chronic Health Evaluation (APACHE) III scores, INR, bleedingepisodes, and transfusion complications. We identified 115 patients with coagulopathy (INR of >1.5) but without active bleeding. A total of 44 patients (38.3%) received FFP transfusion. INR was corrected in 16 of 44 patients (36%) who received transfusion. Median dose of FFP was 17 mL/kgin patients who had INR corrected vs. 10 mL/kgin those who did not ( p .018). There was no difference in age, sex, APACHE III scores, liver disease, Coumadin treatment, or INR level between those who did and did not receive FFP. Invasive procedures (68.2% vs. 40.8%, p .004) and history of recent gastrointestinal bleeding (41% vs. 7%, p < .001) were more frequent in the group with transfusion. Although there was no difference in new bleedingepisodes (6.8% in transfused vs. 2.8% in nontransfused group, p .369), new onset acute lung injury was more frequent in the transfused group (18% vs. 4%, p .021). Adjusted for severity of illness, hospital mortality and intensive care unit length of stay among survivors were not different between the two groups. Conclusion: The risk– benefit ratio of FFP transfusion in critically ill medical patients with coagulopathy may not be favorable. Randomized controlled trials evaluatingrestrictive vs. liberal FFP transfusion strategies are warranted. (Crit Care Med 2005; 33:2667–2671) |
| Databáze: | OpenAIRE |
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