Perioperative coagulation management--fresh frozen plasma

Area of Science:

• Transfusion Medicine
• Hematology
• Critical Care Medicine

Background:

• Clinical evidence supports perioperative fresh frozen plasma (FFP) for active bleeding and dilutional coagulopathy in major trauma.
• Current FFP dosing guidelines may be insufficient for these critical indications.
• A significant amount of FFP is transfused inappropriately in non-bleeding patients, lacking evidence of benefit and exposing them to risks.

Purpose of the Study:

• To review the appropriate clinical applications of FFP.
• To evaluate the risks and benefits of FFP transfusion.
• To discuss alternatives to FFP in various clinical scenarios.

Main Methods:

• Literature review of clinical studies on FFP use.
• Analysis of FFP transfusion practices in bleeding and non-bleeding patients.
• Evaluation of adverse events associated with FFP.

Main Results:

• FFP is indicated for active bleeding and massive hemorrhage prevention.
• Inappropriate FFP use is common in non-bleeding patients and those with mild coagulation abnormalities.
• Adverse effects include febrile reactions, circulatory overload, and acute lung injury; alternatives like FP24 and thawed plasma exist.

Conclusions:

• FFP use should be restricted to evidence-based indications, primarily active bleeding and coagulopathy prevention.
• Non-bleeding patients receiving FFP are unnecessarily exposed to risks.
• Alternatives to FFP, including prothrombin complex concentrates and factor VIIa, require further investigation for specific contexts.