Dose-associated pulmonary complication rates after fresh frozen plasma administration for warfarin reversal
| Autor: | Joshua N. Goldstein, Blair A. Parry, R. T. Callahan, Ariela L. Marshall, Yuchiao Chang, Michael Levine, Melissa L. Howell, Alison M. Ayres, Eric Riklin, I. Okechukwu, Brian V. Nahed |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Acute Lung Injury Blood Component Transfusion Hemorrhage 030204 cardiovascular system & hematology Lung injury Risk Assessment Tertiary Care Centers 03 medical and health sciences Plasma 0302 clinical medicine Risk Factors medicine Odds Ratio Humans 030212 general & internal medicine International Normalized Ratio Blood Coagulation Aged Retrospective Studies Aged 80 and over business.industry Incidence Pulmonary Complication Absolute risk reduction Warfarin Anticoagulants Hematology Odds ratio Middle Aged Pulmonary edema medicine.disease Surgery Logistic Models Anesthesia Multivariate Analysis Female Fresh frozen plasma business Complication Emergency Service Hospital medicine.drug Boston |
| Zdroj: | Journal of thrombosis and haemostasis : JTH. 14(2) |
| ISSN: | 1538-7836 |
| Popis: | Essentials Fresh frozen plasma (FFP) may be associated with a dose-based risk of pulmonary complications. Patients received FFP for warfarin reversal at a large academic hospital over a 3-year period. Almost 20% developed pulmonary complications, and the risk was highest after > 3 units of FFP. The risk of pulmonary complications remained significant in multivariable analysis. SummaryBackground 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 Two hundred and fifty-one patients met the inclusion criteria. Overall, 49 patients (20%) developed pulmonary complications, including 30 (12%) with TACO, two (1%) with TRALI, and 17 (7%) with pulmonary edema not meeting the criteria for TACO. Pulmonary complications were significantly more frequent in those who received > 3 units of FFP (34.0% versus 15.6%, 95% confidence interval for risk difference 7.9%–8.9%). After stratification by subtype of complication, only the risk of TACO was statistically significant (28.3% versus 7.6%, 95% confidence interval for risk difference 8.2%–16.6%). In multivariable analysis controlling for age, sex, initial systolic blood pressure, and intravenous fluids given in the ED, > 3 units of FFP remained a significant risk factor for pulmonary complications (odds ratio 2.49, 95% confidence interval 1.21–5.13). 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. |
| Databáze: | OpenAIRE |
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