Fresh frozen plasma for cardiovascular surgery

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Coagulation Science

Background:

• Fresh frozen plasma (FFP) contains procoagulant factors and is sometimes used in cardiovascular surgery to reduce bleeding risk.
• The current evidence regarding the risk-benefit ratio of FFP transfusion in this patient population is limited.

Purpose of the Study:

• To evaluate the risk-benefit ratio of FFP transfusion in cardiovascular surgery.
• To assess the risk of mortality for patients undergoing cardiovascular surgery who receive FFP, both for treatment and prophylaxis.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included 11 bibliographic and 4 ongoing trials databases, with no language or publication status limitations.
• Fifteen trials with 755 participants were included, assessing FFP use therapeutically or prophylactically.

Main Results:

• No difference in mortality was observed between FFP and control groups (very low quality evidence).
• FFP transfusion was associated with an increased likelihood of receiving red blood cell transfusions (moderate quality evidence).
• No significant difference in reoperation rates was found, but studies were generally small and at high risk of bias.

Conclusions:

• There is no evidence to support prophylactic FFP administration in elective cardiac surgery patients without coagulopathy.
• Insufficient evidence exists regarding FFP use in patients with coagulopathies or undergoing emergency surgery.
• Further adequately powered studies are needed to determine the clinical benefits of FFP or comparable agents.