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Abstract
This article reviews the variety of coagulation testing abnormalities identified and the evidence demonstrating their lack of correlation with hemostasis and inability to predict bleeding for patients with liver disease. The article discusses the historical and incorrect evolution of the commonly used "1.5x" prothrombin time/international normalized ratio "threshold" for fresh frozen plasma/frozen plasma (FFP/FP) administration. Finally, this article reviews why FFP/FP cannot correct minimally prolonged clotting times in patients with liver disease, nor provide adequate prophylaxis against bleeding from percutaneous liver biopsy.
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Affiliation(s)
- Valerie L Ng
- Clinical Laboratory, Highland General Hospital, 1411 East 31st Street, Oakland, CA 94602, USA.
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202
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Rahe-Meyer N, Solomon C, Winterhalter M, Piepenbrock S, Tanaka K, Haverich A, Pichlmaier M. Thromboelastometry-guided administration of fibrinogen concentrate for the treatment of excessive intraoperative bleeding in thoracoabdominal aortic aneurysm surgery. J Thorac Cardiovasc Surg 2009; 138:694-702. [DOI: 10.1016/j.jtcvs.2008.11.065] [Citation(s) in RCA: 182] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 10/28/2008] [Accepted: 11/22/2008] [Indexed: 01/09/2023]
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203
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Gerlach R, Krause M, Seifert V, Goerlinger K. Hemostatic and hemorrhagic problems in neurosurgical patients. Acta Neurochir (Wien) 2009; 151:873-900; discussion 900. [PMID: 19557305 DOI: 10.1007/s00701-009-0409-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 10/22/2008] [Indexed: 01/10/2023]
Abstract
BACKGROUND Abnormalities of the hemostasis can lead to hemorrhage, and on the other hand to thrombosis. Intracranial neoplasms, complex surgical procedures, and head injury have a specific impact on coagulation and fibrinolysis. Moreover, the number of neurosurgical patients on medication (which interferes with platelet function and/or the coagulation systems) has increased over the past years. METHOD The objective of this review is to recall common hemostatic disorders in neurosurgical patients on the basis of the "new concept of hemostasis". Therefore the pertinent literature was searched to provide a structured and up to date manuscript about hemostasis in Neurosurgery. FINDINGS According to recent scientific publications abnormalities of the coagulation system are discussed. Pathophysiological background and the rational for specific (cost)-effective perioperative hemostatic therapy is provided. CONCLUSIONS Perturbations of hemostasis can be multifactorial and maybe encountered in the daily practice of neurosurgery. Early diagnosis and specific treatment is the prerequisite for successful treatment and good patients outcome.
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Affiliation(s)
- Ruediger Gerlach
- Department of Neurosurgery, Johann Wolfgang Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany.
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204
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Vlaar APJ, in der Maur AL, Binnekade JM, Schultz MJ, Juffermans NP. A survey of physicians' reasons to transfuse plasma and platelets in the critically ill: a prospective single-centre cohort study. Transfus Med 2009; 19:207-12. [DOI: 10.1111/j.1365-3148.2009.00928.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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205
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Fresh Frozen Plasma Is Independently Associated With a Higher Risk of Multiple Organ Failure and Acute Respiratory Distress Syndrome. ACTA ACUST UNITED AC 2009; 67:221-7; discussion 228-30. [DOI: 10.1097/ta.0b013e3181ad5957] [Citation(s) in RCA: 244] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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206
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Malloy PC, Grassi CJ, Kundu S, Gervais DA, Miller DL, Osnis RB, Postoak DW, Rajan DK, Sacks D, Schwartzberg MS, Zuckerman DA, Cardella JF. Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions. J Vasc Interv Radiol 2009; 20:S240-9. [DOI: 10.1016/j.jvir.2008.11.027] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 11/24/2008] [Indexed: 01/27/2023] Open
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207
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Plasma frais congelé et apport transfusionnel en chirurgie cardiaque. Ing Rech Biomed 2009. [DOI: 10.1016/s1959-0318(09)74601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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208
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Chou CD, Yien HW, Wu DM, Kuo CD. Albumin administration in patients with severe sepsis due to secondary peritonitis. J Chin Med Assoc 2009; 72:243-50. [PMID: 19467947 DOI: 10.1016/s1726-4901(09)70064-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To determine whether or not intravenous administration of human albumin can reduce mortality in patients with severe sepsis due to secondary peritonitis. METHODS Adult patients who were admitted to the surgical intensive care unit (SICU) who fulfilled the criteria of severe sepsis due to secondary peritonitis were consecutively included in this retrospective study. Patients who received and those who did not receive at least a daily minimum of 25 g intravenous human albumin for 3 days during their first 7 days of SICU admission were classified as the study group and control group, respectively. RESULTS A total of 133 patients were included in this study. For patients with baseline serum albumin < or = 20 g/L, 28-day mortality was significantly lower in the study group. For patients with baseline serum albumin > 20 g/L, albumin administration had no significant effects on 28-day mortality. CONCLUSION For patients with severe sepsis due to secondary peritonitis, albumin administration may reduce 28-day mortality in patients whose baseline serum albumin is < or = 20 g/L, but no such effect was found in patients whose baseline serum albumin was > 20 g/L.
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Affiliation(s)
- Chih-Dou Chou
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C
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209
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Church GD, Matthay MA, Liu K, Milet M, Flori HR. Blood product transfusions and clinical outcomes in pediatric patients with acute lung injury. Pediatr Crit Care Med 2009; 10:297-302. [PMID: 19307809 PMCID: PMC3586190 DOI: 10.1097/pcc.0b013e3181988952] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There are data suggesting that blood product transfusions increase the risk of developing acute lung injury (ALI) in adults, and may be associated with increased mortality in adults with ALI. A possible association between transfusions and adverse outcomes of pediatric patients with ALI has not been studied previously. We tested the hypothesis that blood product transfusions to pediatric patients with ALI within the first 72 hours of the diagnosis would be associated with increased mortality and prolonged mechanical ventilation. DESIGN An epidemiologic database of pediatric ALI prospectively gathered from July 1996 to May 2000 was analyzed. SETTING Children were enrolled from both a tertiary referral hospital and a major community children's hospital. PATIENTS Three hundred fifteen patients who met the 1994 American European Consensus Committee definition of ALI between the ages of 36 weeks corrected gestational age and 18 years. MAIN OUTCOME MEASURE Mortality in the pediatric intensive care unit. RESULTS Multivariate analyses indicated that the transfusion of fresh-frozen plasma (FFP) was associated with increased mortality, independent of the severity of hypoxemia (Pao2/Fio2), presence of multiple organ system failure or disseminated intravascular coagulation (odds ratio = 1.08, 95% confidence interval = 1.00-1.17, p = 0.04). FFP transfusion was analyzed as a continuous variable, so that for each milliliter of FFP transfused per kilogram patient body weight per day, the odds of death increased by 1.08. There was a trend toward an association of the transfusion of FFP with a fewer number of days of unassisted ventilation (regression coefficient = -0.21, 95% confidence interval = -0.42-0.01, p = 0.06). CONCLUSIONS The transfusion of FFP is associated with an increased risk of mortality in children with ALI. The association between FFP and mortality in children with ALI should be investigated further.
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Affiliation(s)
- Gwynne D Church
- Department of Pediatrics, University of California, San Francisco, CA, USA.
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210
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Vigué B. Bench-to-bedside review: Optimising emergency reversal of vitamin K antagonists in severe haemorrhage - from theory to practice. Crit Care 2009; 13:209. [PMID: 19486503 PMCID: PMC2689453 DOI: 10.1186/cc7701] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Critical care physicians are increasingly facing patients receiving oral anticoagulation for either cessation of major haemorrhage or to reverse the effects of vitamin K antagonists ahead of emergency surgery. Rapid reversal of anticoagulation is particularly essential in cases of life-threatening bleeding. In these situations, guidelines recommend the concomitant administration of prothrombin complex concentrates (PCCs) and oral or intravenous vitamin K for the fastest normalisation of the international normalised ratio (INR). Despite their universal recommendation, PCCs remain underused by many physicians who prefer to opt for fresh frozen plasma despite its limitations in anticoagulant reversal, including time to reverse INR and high risk of transfusion-related acute lung injury. In contrast, the lower volume required to normalise INR with PCCs and the room temperature storage facilitate faster preparation and administration time, thus increasing the speed at which haemorrhages can be treated. PCCs therefore allow faster, more reliable and complete reversal of vitamin K anticoagulation, especially when administered immediately following confirmation of haemorrhage. In the emergency setting, probabilistic dosing may be considered.
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Affiliation(s)
- Bernard Vigué
- AP-HP, Université Paris-Sud, Hôpital de Bicêtre, Département d'Anesthésie-Réanimation, F-94275, Le Kremlin-Bicêtre, France.
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211
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212
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Time for changing coagulation management in trauma-related massive bleeding. Curr Opin Anaesthesiol 2009; 22:267-74. [DOI: 10.1097/aco.0b013e32832678d9] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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213
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Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion of plasma and platelets. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2009; 7:132-50. [PMID: 19503635 PMCID: PMC2689068 DOI: 10.2450/2009.0005-09] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Giancarlo Liumbruno
- UU.OO.CC. di Immunoematologia e Medicina Trasfusionale e Patologia Clinica, Ospedale San Giovanni Calibita Fatebenefratelli, Roma, Italy.
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214
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Brunskill SJ, Hyde CJ, Stanworth SJ, Dorée CJ, Roberts DJ, Murphy MF. Improving the evidence base for transfusion medicine: the work of the UK systematic review initiative. Transfus Med 2009; 19:59-65. [PMID: 19320853 DOI: 10.1111/j.1365-3148.2009.00910.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clarifying the existing evidence base is crucial to improve the effectiveness of transfusion practice. The UK Systematic Review Initiative has been pursuing this objective primarily through writing systematic reviews on important topics in transfusion medicine. Here, we describe our progress for the past 5 years. We are the only research group that identifies transfusion medicine randomized controlled trials (RCTs) for the Cochrane Central Register of Controlled Trials, and to date, we have contributed 3002 RCT citations. The article considers future challenges including the need for wider involvement from the transfusion medicine community in the process of maintaining and updating systematic reviews and the identification and prioritization of topics for further clinical research including clinical trials. Collaboration between international and local research groups is important if these challenges are to be met.
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Affiliation(s)
- S J Brunskill
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
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215
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Management der Gerinnungsstörung bei traumainduzierter Hypovolämie und (un-)kontrollierter Blutung. Notf Rett Med 2009. [DOI: 10.1007/s10049-008-1144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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216
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Affiliation(s)
- Don C Rockey
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA.
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217
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Chapman CE, Stainsby D, Jones H, Love E, Massey E, Win N, Navarrete C, Lucas G, Soni N, Morgan C, Choo L, Cohen H, Williamson LM. Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma. Transfusion 2009; 49:440-52. [DOI: 10.1111/j.1537-2995.2008.01948.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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218
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Argo CK, Balogun RA. Blood products, volume control, and renal support in the coagulopathy of liver disease. Clin Liver Dis 2009; 13:73-85. [PMID: 19150312 DOI: 10.1016/j.cld.2008.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Plasma-based products are commonly used in patients who have chronic liver disease to treat perceived coagulopathy despite unproven efficacy and potentially severe risks, such as transfusion-related acute lung injury, which carries a high mortality rate. Moreover, volume expansion may acutely worsen portal hypertension and increase bleeding from the collateral portal vascular bed. Although factor replacement therapy may be warranted in selected situations, its use should be restricted because of the limitations of target tests, such as international normalized ratio, which poorly reflects presence of bleeding diatheses in patients who have cirrhosis. Renal replacement therapies are frequent adjuncts in patients who have cirrhosis and are acutely decompensated, and may correct uremia-related bleeding diathesis and assist in controlling vascular volume, although they are generally limited to use as a bridge to liver transplantation. Novel extracorporeal therapies are emerging and may also have significant interaction with the hemostatic system. Volume contraction and blood conservation therapies are relatively new and promising approaches to reduce use of blood products in liver transplantation.
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Affiliation(s)
- Curtis K Argo
- University of Virginia, Department of Medicine, Division of Gastroenterology and Hepatology, Box 800708, Charlottesville, VA, USA.
| | - Rasheed A Balogun
- University of Virginia, Department of Medicine, Division of Nephrology, Charlottesville, VA, USA
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219
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Poterjoy BS, Josephson CD. Platelets, frozen plasma, and cryoprecipitate: what is the clinical evidence for their use in the neonatal intensive care unit? Semin Perinatol 2009; 33:66-74. [PMID: 19167583 DOI: 10.1053/j.semperi.2008.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transfusion of blood components such as platelets, frozen plasma, and cryoprecipitate is a common practice in the neonatal intensive care unit. Although it is intuitive that these components would be transfused in the context of bleeding, their use in neonatology has often been on a prophylactic basis. Due to a lack of consensus guidelines regarding indications for transfusion, however, the neonatologist is left to his/her opinion as to when to transfuse. This article seeks to review the available evidence regarding the use of platelets, frozen plasma, and cryoprecipitate in neonates, as well as the risks associated with the administration of these products.
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Affiliation(s)
- Brandon S Poterjoy
- Division of Neonatal/Perinatal Medicine, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
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220
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Wood EM, Stanworth S, Doree C, Hyde C, Silvani CM, Montedori A, Abraha I. Fresh frozen plasma for cardiovascular surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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221
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An FFP:PRBC transfusion ratio >/=1:1.5 is associated with a lower risk of mortality after massive transfusion. ACTA ACUST UNITED AC 2008; 65:986-93. [PMID: 19001962 DOI: 10.1097/ta.0b013e3181878028] [Citation(s) in RCA: 258] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population. METHODS Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Those patients who required >/=8 units PRBCs within the first 12 hours postinjury were analyzed (n = 415). RESULTS Patients who received transfusion products in >/=1:1.50 FFP:PRBC ratio (high F:P ratio, n = 102) versus <1:1.50 FFP:PRBC ratio (low F:P, n = 313) required significantly less blood transfusion at 24 hours (16 +/- 9 units vs. 22 +/- 17 units, p = 0.001). Crude mortality differences between the groups did not reach statistical significance (high F:P 28% vs. low F:P 35%, p = 0.202); however, there was a significant difference in early (24 hour) mortality (high F:P 3.9% vs. low F:P 12.8%, p = 0.012). Cox proportional hazard regression revealed that receiving a high F:P ratio was independently associated with 52% lower risk of mortality after adjusting for important confounders (HR 0.48, p = 0.002, 95% CI 0.3-0.8). A high F:P ratio was not associated with a higher risk of organ failure or nosocomial infection, however, was associated with almost a twofold higher risk of acute respiratory distress syndrome, after controlling for important confounders. CONCLUSIONS In patients requiring >/=8 units of blood after serious blunt injury, an FFP:PRBC transfusion ratio >/=1:1.5 was associated with a significant lower risk of mortality but a higher risk of acute respiratory distress syndrome. The mortality risk reduction was most relevant to mortality within the first 48 hours from the time of injury. These results suggest that the mortality risk associated with an FFP:PRBC ratio <1:1.5 may occur early, possibly secondary to ongoing coagulopathy and hemorrhage. This analysis provides further justification for the prospective trial investigation into the optimal FFP:PRBC ratio required in massive transfusion practice.
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222
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De Backer D, Vandekerckhove B, Stanworth S, Williamson L, Hermans C, Van der Linden P, Hübner R, Baele P, Jochmans K, Ferrant A, Lambermont M, Muylle L, Toungouz M. Guidelines for the use of fresh frozen plasma. Acta Clin Belg 2008; 63:381-90. [PMID: 19170354 DOI: 10.1179/acb.2008.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Recommendations, which aim at standardising and rationalising clinical indications for the transfusion of fresh frozen plasma (FFP) in Belgium, were drawn up by a working group of the Superior Health Council. For this purpose the Superior Health Council organised an expert meeting devoted to "Transfusion Guidelines: Pathogen reduction, products and indications for the transfusion of plasma" in collaboration with the Belgian Haematological Society.The experts discussed the indications for the transfusion of FFP, pathogen reduction for FFP and the practical issues of administering FFP and plasma-derived concentrates. The recommendations formulated by the experts were validated by the working group with the purpose of harmonising FFP transfusion in Belgian hospitals.
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Affiliation(s)
- D De Backer
- Service Soins Intensifs, Hôpital universitaire Erasme (ULB), Bruxelles, Belgique.
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223
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Lawrie AS, Harrison P, Cardigan RA, Mackie IJ. The characterization and impact of microparticles on haemostasis within fresh-frozen plasma. Vox Sang 2008; 95:197-204. [DOI: 10.1111/j.1423-0410.2008.01081.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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224
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Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma:packed red blood cells the answer? ACTA ACUST UNITED AC 2008; 65:261-70; discussion 270-1. [PMID: 18695460 DOI: 10.1097/ta.0b013e31817de3e1] [Citation(s) in RCA: 236] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent military experience suggests that immediate 1:1 fresh frozen plasma (FFP); red blood cells (RBC) for casualties requiring >10 units packed red blood cells (RBC) per 24 hours reduces mortality, but no clinical trials exist to address this issue. Consequently, we reviewed our massive transfusion practices during a 5-year period to test the hypothesis that 1:1 FFP:RBC within the first 6 hours reduces life threatening coagulopathy. METHODS We queried our level I trauma center's prospective registry from 2001 to 2006 for patients undergoing massive transfusion. Logistic regression was used to evaluate the independent effect of FFP:RBC in 133 patients who received >10 units RBC in 6 hours on (1) Coagulopathy (international normalized ratio [INR] >1.5 at 6 hours), controlling for our previously described risk factors predictive of coagulopathy, as well as RBC, FFP, and platelet administration (2) Death (controlling for all variables plus age, crystalloids per 24 hours, INR >1.5 at 6 hours). RESULTS Overall mortality was 56%; 50% died from acute blood loss in the operating room. Over 80% of the RBC transfusions were completed in the first 6 hours: (Median RBC: 18 units) Median FFP:RBC survivors, 1:2, nonsurvivors: 1:4. (p < 0.001) INR >1.5 at 6 hours occurred in 30 (23%); 81% died. Regarding mortality, logistic regression showed significant variables (p < 0.05) included: RBC per 6 hours (OR = 1.248, 95%CI: 1.957-53.255), INR at 6 hours >1.5 (OR = 10.208, 95% CI: 1.957-53.255), ED temperature <34 degrees C (OR = 15.491, 95% CI 1.376-174.396), and age >55 years (OR = 40.531, CI 5.315-309.077). The adjusted OR for FFP:RBC ratio including the quadratic term was found to follow a U-shaped association (quadratic term estimate 0.6737 +/- 0.0345, p = 0.0189). CONCLUSION Although our data suggest that 1:1 FFP:RBC reduced coagulopathy, this did not translate into a survival benefit. Our findings indicate that the relationship between coagulopathy and mortality is more complex, and further clinical investigation is necessary before recommending routine 1:1 in the exsanguinating trauma patient.
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225
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226
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Transfusion-transmissible infections and transfusion-related immunomodulation. Best Pract Res Clin Anaesthesiol 2008; 22:503-17. [DOI: 10.1016/j.bpa.2008.05.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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227
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Meller R, Krettek C. [Successful treatment of perioperative coagulation problems]. Unfallchirurg 2008; 111:573. [PMID: 18704539 DOI: 10.1007/s00113-008-1499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Meller
- Medizinische Hochschule Hannover, Unfallchirurgische Klinik, Hannover
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228
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Heindl B, Biberthaler P. Gerinnungsmanagement bei schweren operativen Blutungen. Unfallchirurg 2008; 111:574-8, 580-3. [DOI: 10.1007/s00113-008-1485-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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229
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Stanworth SJ, Bennett C. How to tackle bleeding and thrombosis in the newborn. Early Hum Dev 2008; 84:507-13. [PMID: 18625545 DOI: 10.1016/j.earlhumdev.2008.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 06/03/2008] [Indexed: 01/04/2023]
Abstract
Bleeding and its management represent common clinical problems in neonatal intensive care, particularly in pre-term infants. Frank and severe single organ haemorrhage (e.g. pulmonary or gastrointestinal in association with necrotising enterocolitis) is less common, but may require urgent resuscitation and clinical stabilisation. Intracranial bleeding is always potentially of greatest concern because of the neurological consequences, but the pathophysiological mechanism of the most characteristic form, intraventricular haemorrhage, remains incomplete. Minor forms of bleeding are commonly seen in sicker neonates, ranging from blood stained endotracheal secretions to longer than expected oozing from phlebotomy sites, but may be manifestations of disseminated intravascular coagulation. The mainstay of treatment for bleeding in association with abnormalities of coagulation or thrombocytopenia remains blood products, although their role as prophylaxis to prevent bleeding in neonates without clinical signs of haemorrhage is less clear. The overwhelming majority of thromboembolic events in neonates occur in association with arterial or venous catheters, but the clinical features are very variable, including catheter dysfunction and local signs. The optimal treatment strategies including use of anticoagulants remain problematic in the absence of good clinical trials.
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Affiliation(s)
- Simon J Stanworth
- Paediatric haematology/National Blood Service, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.
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230
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Hellstern P. Fresh-frozen plasma, pathogen-reduced single-donor plasma or bio-pharmaceutical plasma? Transfus Apher Sci 2008; 39:69-74. [DOI: 10.1016/j.transci.2008.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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231
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232
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Retrospective evaluation of a method to predict fresh-frozen plasma dosage in anticoagulated patients. Am J Ther 2008; 15:111-8. [PMID: 18356630 DOI: 10.1097/mjt.0b013e3180ed4345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the United States, fresh-frozen plasma (FFP) is commonly used for urgent reversal of warfarin; however, dosage recommendations are difficult to find. If validated, a proposed method that uses a nonlinear relationship between international normalized ratio (INR) and clotting factor activity (CFa) would be useful. This study retrospectively evaluated a proposed equation with adult medical inpatients who received FFP for warfarin reversal. For each patient the equation was used to predict the dose of FFP required to achieve the observed change in INR, which was then compared to the actual dose. The equation was considered successful if the predicted dose was within +/-20% of the actual dose. Subgroup analyses included subjects who received concomitant vitamin K; subjects with supratherapeutic INRs (>3); and subjects with significantly elevated INRs (>5). Of the 209 patients screened, 91 met criteria for inclusion in the study. Use of the equation to calculate the predicted dose of FFP was successful in 11 patients (12.1%) with use of actual body weight for prediction and in 23 patients (25.3%) with use of ideal body weight (P = 0.02). The equation performed similarly in all subgroups analyzed. The mean predicted FFP dose was significantly greater than the actual dose in all patients when actual body weight was used (925.2 mL vs. 620.6 mL; P < 0.001). Least-squares regression modeling of repeat INR (converted to CFa) produced a model that accounted for 57% of the variance in repeat INR. The value predicted from the model was closer to the actual CFa than was the value predicted from the published equation in every comparison, but it was statistically different only when actual body weight was used. This study revealed that a published equation for calculation of FFP dose to reverse oral anticoagulation resulted in doses that were significantly higher than the actual dose. Use of ideal body weight improved accuracy but was still not successful for the majority of patients. Until trials are able to prospectively demonstrate the accuracy of a dose-prediction model for FFP, dosing will remain largely empiric.
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233
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Spiess BD. Treating Heparin Resistance With Antithrombin or Fresh Frozen Plasma. Ann Thorac Surg 2008; 85:2153-60. [DOI: 10.1016/j.athoracsur.2008.02.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 02/12/2008] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
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234
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Haas T, Fries D, Velik-Salchner C, Reif C, Klingler A, Innerhofer P. The In Vitro Effects of Fibrinogen Concentrate, Factor XIII and Fresh Frozen Plasma on Impaired Clot Formation After 60% Dilution. Anesth Analg 2008; 106:1360-5, table of contents. [DOI: 10.1213/01.ane.0b013e3181684339] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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235
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Transfusion of fresh frozen plasma in critically ill surgical patients is associated with an increased risk of infection. Crit Care Med 2008; 36:1114-8. [PMID: 18379235 DOI: 10.1097/ccm.0b013e318168f89d] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether there is an association between transfusion of fresh frozen plasma and infection in critically ill surgical patients. DESIGN Retrospective study. SETTING A 24-bed surgical intensive care unit in a university hospital. PATIENTS A total of 380 non-trauma patients who received fresh frozen plasma from 2004 to 2005 were compared with 2,058 nontrauma patients who did not receive fresh frozen plasma. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We calculated the relative risk of infectious complication for patients receiving and not receiving fresh frozen plasma. T-test allowed comparison of average units of fresh frozen plasma transfused to patients with and without infectious complications to describe a dose-response relationship. We used multivariate logistic regression analysis to evaluate the association between fresh frozen plasma and infectious complication, controlling for the effect of red blood cell transfusion, Acute Physiology and Chronic Health Evaluation II, and patient age. A significant association was found between transfusion of fresh frozen plasma and ventilator-associated pneumonia with shock (relative risk 5.42, 2.73-10.74), ventilator-associated pneumonia without shock (relative risk 1.97, 1.03-3.78), bloodstream infection with shock (relative risk 3.35, 1.69-6.64), and undifferentiated septic shock (relative risk 3.22, 1.84-5.61). The relative risk for transfusion of fresh frozen plasma and all infections was 2.99 (2.28-3.93). The t-test revealed a significant dose-response relationship between fresh frozen plasma and infectious complications (p = .02). Chi-square analysis showed a significant association between infection and transfusion of fresh frozen plasma in patients who did not receive concomitant red blood cell transfusion (p < .01), but this association was not significant in those who did receive red blood cells in addition to fresh frozen plasma. The association between fresh frozen plasma and infectious complications remained significant in the multivariate model, with an odds ratio of infection per unit of fresh frozen plasma transfused equal to 1.039 (1.013-1.067). This odds ratio resembled that noted for each unit of packed red blood cells, 1.074 (1.043-1.106). CONCLUSIONS Transfusion of fresh frozen plasma is associated with an increased risk of infection in critically ill patients.
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236
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Stanworth SJ, Hyde CJ, Murphy MF. Evidence for indications of fresh frozen plasma. Transfus Clin Biol 2008; 14:551-6. [PMID: 18430602 DOI: 10.1016/j.tracli.2008.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 11/28/2022]
Abstract
There continues to be a general but unfounded enthusiasm for fresh frozen plasma (FFP) usage across a range of clinical specialties in hospital practice. Clinical use of plasma has grown steadily over the last two decades in many countries. In England and Wales, there has not been a significant reduction in the use of FFP over the last few years, unlike red cells. There is also evidence of variation in usage among countries--use in England and Wales may be proportionately less per patient than current levels of usage in other European countries and the United States. Plasma for transfusion is most often used where there is abnormal coagulation screening tests, either therapeutically in the face of bleeding, or prophylactically in non-bleeding subjects prior to invasive procedures or surgery. Little evidence exists to inform best therapeutic plasma transfusion practice. Most studies have described plasma use in a prophylactic setting, in which laboratory abnormalities of coagulation tests are considered a predictive risk factor for bleeding prior to invasive procedures. The strongest randomised controlled trial (RCT) evidence indicates that prophylactic plasma for transfusion is not effective across a range of different clinical settings and this is supported by data from non-randomised studies in patients with mild to moderate abnormalities in coagulation tests. There are also uncertainties whether plasma consistently improves the laboratory results for patients with mild to moderate abnormalities in coagulation tests. There is a need to undertake new trials evaluating the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients, to understand whether the "presumed" benefits outweigh the "real risks". In addition, new haemostatic tests should be validated which better define risk of bleeding.
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Affiliation(s)
- S J Stanworth
- National Blood Service, John Radcliffe Hospital, Osler Road, Headington, Oxford, United Kingdom.
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237
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Algora M, Barbolla L. Uses of plasma in Spain. Transfus Clin Biol 2008; 14:564-7. [PMID: 18417402 DOI: 10.1016/j.tracli.2008.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 10/22/2022]
Abstract
In Spain, fresh frozen plasma (FFP) currently recovered either by whole blood centrifugation or by apheresis is mainly considered as a source of plasma derivates rather than a product to be transfused. Upon this consideration, the amount of plasma transfused in the last two decades has remained stable, while the production of FFP has grown steadily during all these years. Thus, much more plasma has been derived to industry for manufacturing. Although, since 1993 a consensus conference established the clinical situation where plasma has demonstrated its efficacy, the true situation is that many indications seem not to be supported on a scientific evidence basis. Only a few studies have been performed in the last years to assess the appropriateness of these indications. We present the initial result of an ongoing survey addressed by the Madrid Blood Transfusion Centre. Based on the criteria of total amount of RBC transfused per year, large hospitals (more than 10,000 units of RBC) transfused an average of 23.87% of FFP, while medium hospitals (5000-10,000 units of RBC) used 19.5% and small ones (less than 5000) about 12.5%. It is important to point out that inside each group there were some important differences in ratio values for similar hospitals. This could indicate that much more is necessary to cope with indications. Although national figures of uses of FFP, whether in ratio or absolute terms, show a moderate consumption in comparison with published figures of other European countries, there can be no doubt that plasma overuses still seem to be present.
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Affiliation(s)
- M Algora
- Centro de Transfusión de Madrid, Avda. de la democracia s/n, Madrid, Spain.
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238
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Dickneite G, Doerr B, Kaspereit F. Characterization of the Coagulation Deficit in Porcine Dilutional Coagulopathy and Substitution with a Prothrombin Complex Concentrate. Anesth Analg 2008; 106:1070-7, table of contents. [DOI: 10.1213/ane.0b013e318165dfbb] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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239
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Abstract
It is estimated that 10 000 people per year die following trauma in England and Wales and 30—40% do so due to uncontrolled haemorrhage. By the time the patient reaches hospital, coagulopathy is often already installed and needs to be corrected promptly to prevent further haemorrhage and allow effective treatment of injuries. The coagulopathy is multifactorial with the leading causes being acidosis, hypothermia and massive transfusion. Early recognition of the condition is imperative using standard coagulation testing; however, there are limitations in this setting. Newer methods of testing `global haemostasis' using thromboelastography are becoming more popular but need further validation. Treatment of coagulopathy requires a multidisciplinary approach. Blood product transfusion remains the cornerstone of management but newer pharmacological agents such as recombinant factor VIIa are increasingly being used. Here we review the pathogenesis, investigation and management of the coagulopathy of trauma.
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Affiliation(s)
- Vickie McDonald
- Haemostasis Research Unit, University College London, , Department of Haematology, University College London, London, UK
| | - Kim Ryland
- Haemostasis Research Unit, University College London, , Department of Haematology, University College London, London, UK
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240
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Danés AF, Cuenca LG, Bueno SR, Mendarte Barrenechea L, Ronsano JBM. Efficacy and tolerability of human fibrinogen concentrate administration to patients with acquired fibrinogen deficiency and active or in high-risk severe bleeding. Vox Sang 2008; 94:221-226. [PMID: 18179679 DOI: 10.1111/j.1423-0410.2007.01024.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Fibrinogen deficiency is a cause for massive haemorrhage whose management in emergency situations is the subject of debate. Plasma-derived fibrinogen concentrates are indicated for reversing the haemorrhagic diathesis found in congenital and acquired deficiencies. MATERIALS AND METHODS We report on the results of an observational study that evaluated the effects of fibrinogen concentrates in patients suffering from various forms of acquired severe hypofibrinogenaemia with life-threatening consumptive thrombo-haemorrhagic disorders (surgery, trauma and digestive haemorrhage), or underlying disease states that limit fibrinogen synthesis (hepatic dysfunction, haematological malignancies). RESULTS Sixty-nine patients were identified and included, in whom most of the processes (62%) corresponded to consumptive hypofibrinogenaemia. After a median dose of 4 g, a mean absolute increase of 1.09 g/l in plasma fibrinogen was measured and coagulation parameters were significantly improved (P < 0.001). Mortality rates of 32.3% and 44.2% were reported after 24 h and 72 h, respectively. CONCLUSION We conclude that the administration of fibrinogen concentrates in unresponsive, life-threatening haemorrhage with acquired hypofibrinogenaemia improves laboratory measures of coagulation, and may also be life saving. Although observational in nature, our data indicate a direct relationship between plasma fibrinogen levels and survival in acquired fibrinogen deficiency. Further studies are warranted to ascertain a clear relationship between fibrinogen levels and survival.
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Affiliation(s)
| | - L Gallur Cuenca
- Haematology Service, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - S Rodríguez Bueno
- Haematology Service, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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241
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Jámbor C, Bremerich D, Moritz A, Seifried E, Zwissler B. Gerinnungsmanagement bei Eingriffen mit extrakorporaler Zirkulation. Anaesthesist 2008; 57:374-81. [DOI: 10.1007/s00101-008-1336-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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242
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Webert KE, Cserti CM, Hannon J, Lin Y, Pavenski K, Pendergrast JM, Blajchman MA. Proceedings of a Consensus Conference: pathogen inactivation-making decisions about new technologies. Transfus Med Rev 2008; 22:1-34. [PMID: 18063190 PMCID: PMC7127103 DOI: 10.1016/j.tmrv.2007.09.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Significant progress has been made in reducing the risk of pathogen transmission to transfusion recipients. Nonetheless, there remains a continuing risk of transmission of viruses, bacteria, protozoa, and prions to recipients. These include many of the viruses for which specific screening tests exist as well as pathogens for which testing is currently not being done, including various species of bacteria, babesiosis, variant Creutzfeld-Jacob disease, hepatitis A virus, human herpes virus 8, chikungunya virus, Chagas disease, and malaria. Pathogen inactivation (PI) technologies potentially provide an additional way to protect the blood supply from emerging agents and also provide additional protection against both known and as-yet-unidentified agents. However, the impact of PI on product quality and recipient safety remains to be determined. The purpose of this consensus conference was to bring together international experts in an effort to consider the following issues with respect to PI: implementation criteria; licensing requirements; blood service and clinical issues; risk management issues; cost-benefit impact; and research requirements. These proceedings are provided to make available to the transfusion medicine community the considerable amount of important information presented at this consensus conference.
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Affiliation(s)
- Kathryn E Webert
- Medical, Scientific, and Research Affairs, Canadian Blood Services, Hamilton, Edmonton and Toronto, Canada.
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243
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Kirkman E, Watts S, Hodgetts T, Mahoney P, Rawlinson S, Midwinter M. A Proactive Approach to the Coagulopathy of Trauma: The Rationale and Guidelines for Treatment. J ROY ARMY MED CORPS 2007; 153:302-6. [DOI: 10.1136/jramc-153-04-17] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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244
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Katz LM, Kiss JE. Plasma for transfusion in the era of transfusion-related acute lung injury mitigation. Transfusion 2007; 48:393-7. [PMID: 18028267 DOI: 10.1111/j.1537-2995.2007.01535.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, IA 52807, USA.
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245
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Schmid S, Friesenecker B, Lorenz I, Innerhofer P, Koscielny J, Velik-Salchner C, Mutz N, Fries D. Administration of recombinant activated factor VII (NovoSeven) in three cases of uncontrolled bleeding caused by disseminated intravascular coagulopathy. Clin Appl Thromb Hemost 2007; 13:313-7. [PMID: 17636194 DOI: 10.1177/1076029607302567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Recombinant activated factor VII has been used successfully in many cases of traumatic and surgical bleeding complications that were unresponsive to standard treatment. However, because disseminated intravascular coagulation can develop from a thrombin burst as a side effect of recombinant activated factor VII, it is not yet established for bleeding complications induced by disseminated intravascular coagulation. This article presents 3 patients with severe sepsis and fulminant disseminated intravascular coagulation. Excessive microvascular bleeding persisted despite conventional therapy, and surgical intervention and radiologic embolization did not control bleeding. After administration of recombinant activated factor VII, bleeding ceased in all patients, and no overt thromboembolic events occurred. One patient survived to be discharged from the hospital. The other 2 patients died from refractory multiorgan failure and overall poor prognosis. Recombinant factor VIIa might be an option for the treatment of severe bleeding complications in the case of DIC refractory to the conventional therapy.
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Affiliation(s)
- Stefan Schmid
- Department of General and Surgical Critical Care Medicine, Innsbruck Medical University, Austria
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248
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Lauzier F, Cook D, Griffith L, Upton J, Crowther M. Fresh frozen plasma transfusion in critically ill patients. Crit Care Med 2007; 35:1655-9. [PMID: 17522577 DOI: 10.1097/01.ccm.0000269370.59214.97] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although guidelines for fresh frozen plasma (FFP) use have been published, many transfusions are considered inappropriate. Current guidelines suggest few circumstances in which FFP transfusion to critically ill patients is warranted. The objectives of this study were to evaluate the consistency of Canadian guidelines for FFP administration to critically ill patients and to examine factors associated with inappropriate FFP transfusions. DESIGN Retrospective cohort study. SETTING 15-bed medical surgical intensive care unit in a teaching hospital. PATIENTS 254 consecutive adults admitted during 1 yr expected to stay in intensive care for more than 72 hrs. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Patient demographics, illness severity, life support, intensive care and hospital length of stay, and survival were prospectively collected. All FFP orders were identified from the hospital laboratory information system. For each order, coagulation parameters, planned invasive interventions, recent or current bleeding, and bleeding severity were retrospectively collected. Three observers independently adjudicated whether transfusions were consistent with guidelines, inconsistent but appropriate for the intensive care context, or inappropriate. Of 254 patients, 76 (29.9%) received FFP, accounting for 225 orders to transfuse 547 units. Of 225 orders, 73 (32.4%) were consistent with guidelines, 45 (20.0%) were inconsistent but appropriate, and 107 (47.6%) were inappropriate. Considering transfusions clustered within patients, chance-independent agreement on whether transfusions were inappropriate or not was high (phi 0.73, 0.64-0.81). Independent determinants of inappropriate FFP were the presence of less severe coagulopathy as indicated by lower international normalized ratios (p < .0001) and the absence of bleeding (p < .0001) of planned invasive procedure (p = .0001). CONCLUSIONS Critically ill patients frequently receive inappropriate FFP transfusions. Many transfusions may be appropriate for the intensive care setting, although they are inconsistent with expert recommendations, highlighting that further studies are needed to assess the effectiveness and safety of FFP transfusion in critical illness.
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Affiliation(s)
- François Lauzier
- Department of Medicine, Division of Critical Care, Centre Hospitalier Universitaire Affilié de Québec, Hôpital de l'Enfant-Jésus, Québec, Canada.
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249
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Cocchi MN, Kimlin E, Walsh M, Donnino MW. Identification and Resuscitation of the Trauma Patient in Shock. Emerg Med Clin North Am 2007; 25:623-42, vii. [PMID: 17826209 DOI: 10.1016/j.emc.2007.06.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article focuses on rapid diagnosis and treatment of the patient suffering from trauma-related shock, including early identification of patients at risk for occult hypoperfusion. Resuscitation strategies (delayed resuscitation, damage control resuscitation), end points of resuscitation, and the role of blood products and pro-coagulants for resuscitation are discussed.
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Affiliation(s)
- Michael N Cocchi
- Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, One Deaconess Road, West Campus Clinical Center, 2nd Floor, Boston, MA 02215, USA
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250
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Murphy MF, Brunskill S, Stanworth S, Dorée C, Roberts D, Hyde C. The strengths and weaknesses of the evidence base for transfusion medicine. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1751-2824.2007.00094.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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