Document Detail


Factors associated with prophylactic plasma transfusion before vascular catheterization in non-bleeding critically ill adults with prolonged prothrombin time: a case-control study.
MedLine Citation:
PMID:  23025970     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Fresh-frozen plasma (FFP) is widely used in critically ill patients, despite a weak evidence base. Factors that influence the decision to transfuse FFP before intravascular catheter insertion are poorly described.
METHODS: We undertook a case-controlled study based on a prospective cohort study of 1923 admissions to 29 intensive care units in the UK. Non-bleeding patients with an international normalized ratio (INR) ≥1.5 who underwent intravascular catheterization, but no other invasive procedure, were identified. We compared patient characteristics, illness-related factors, and biochemical and haematological variables between patients who did or did not receive pre-procedural FFP.
RESULTS: One hundred and eighty-six patients fulfilled the criteria; 26 received FFP during the 24 h before line insertion (cases) and 160 did not (controls). Factors associated with greater use of prophylactic FFP by clinicians were pre-existing chronic liver disease (P=0.01), higher serum bilirubin before procedure (P=0.01), lower platelet count (P=0.01), higher activated partial thromboplastin time (P=0.001), lower fibrinogen (P=0.01), and concurrent red cell transfusion despite the absence of bleeding (P=0.001). There was no difference in pre-procedural INR [median (1st, 3rd quartile) cases: 1.95 (1.85, 2.6); controls 1.8 (1.6, 2.3); P=0.19]. The mean FFP dose was 11.1 ml kg(-1) (sd 5.7 ml kg(-1)); 53.8% of cases were transfused <10 ml kg(-1).
CONCLUSIONS: Chronic liver disease and more abnormal coagulation tests were associated with greater probability of pre-procedural FFP administration before vascular catheterization, whereas the severity of prothrombin time prolongation alone was not. FFP was more likely to be administered when red cells were also transfused, even in the absence of bleeding.
Authors:
D P Hall; N I Lone; D M Watson; S J Stanworth; T S Walsh;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-09-30
Journal Detail:
Title:  British journal of anaesthesia     Volume:  109     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-16     Completed Date:  2013-01-31     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  919-27     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Bilirubin / blood
Blood Component Transfusion / methods*
Case-Control Studies
Catheterization, Central Venous*
Catheterization, Peripheral*
Cohort Studies
Critical Care
Critical Illness
Erythrocyte Transfusion / methods
Female
Fibrinogen
Great Britain
Humans
Liver Diseases / blood,  complications
Male
Middle Aged
Partial Thromboplastin Time
Plasma
Platelet Count
Prospective Studies
Prothrombin Time*
Grant Support
ID/Acronym/Agency:
G0901697//Medical Research Council
Chemical
Reg. No./Substance:
9001-32-5/Fibrinogen; RFM9X3LJ49/Bilirubin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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