Fresh frozen plasma transfusion fails to influence the hemostatic balance in critically ill patients with a coagulopathy: comment

Abstract

SummaryBackground Coagulopathy has a high prevalence in critically ill patients. An increased International Normalized Ratio (INR) is a common trigger to transfuse fresh frozen plasma (FFP), even in the absence of bleeding. Therefore, FFP is frequently administered to these patients. However, the efficacy of FFP in correcting hemostatic disorders in non-bleeding recipients has been questioned. Objectives To assess whether INR prolongation parallels changes in the results of other tests investigating hemostasis, and to evaluate the coagulant effects of a fixed dose of FFP in non-bleeding critically ill patients with a coagulopathy. Methods Markers of coagulation, individual factor levels and levels of natural anticoagulants were measured. Also, thrombin generation and thromboelastometry (ROTEM) assays were performed before and after FFP transfusion (12 mL kg−1) to 38 non-bleeding critically ill patients with an increased INR (1.5–3.0). Results At baseline, levels of factor II, FV, FVII, protein C, protein S and antithrombin were reduced, and thrombin generation was impaired. ROTEM variables were within reference ranges, except for a prolonged INTEM clot formation time. FFP transfusion increased the levels of coagulation factors (FII, 34% [interquartile range (IQR) 26–46] before vs. 44% [IQR 38–52] after; FV, 48% [IQR 28–76] before vs. 58% [IQR 44–90] after; and FVII, 25% [IQR 16–38] before vs. 37% [IQR 28–55] after), and the levels of anticoagulant proteins. Thrombin generation was unaffected by FFP transfusion (endogenous thrombin potential, 72% [IQR 51–88] before vs. 71% [IQR 42–89] after), whereas ROTEM EXTEM clotting time and maximum clot firmness slightly improved in response to FFP. Conclusion In non-bleeding critically ill patients with a coagulopathy, FFP transfusion failed to induce a more procoagulant state.