From the Guidelines
Fresh Frozen Plasma (FFP) transfusion in post-resection anastomosis cases is recommended when there is documented coagulopathy with active bleeding or before invasive procedures in patients with significant coagulation abnormalities, as indicated by an INR greater than 1.5, according to the most recent guidelines 1.
Key Indications for FFP Transfusion
- Major haemorrhage, often administered in a more balanced ratio with RBCs (usually 1:1 or 1:1.5) until results of coagulation tests are available
- Disseminated intravascular coagulation (DIC) with evidence of bleeding or at high risk of bleeding
- Reversal of warfarin anticoagulation in the presence of active bleeding if prothrombin complex is not available
Dosage and Administration
- The typical dose is 10-15 mL/kg (approximately 3-4 units for an average adult), with each unit expected to increase clotting factors by about 10% 1
- Transfusion should be completed within 4 hours of thawing, and patients should be monitored for volume overload, particularly those with cardiac or renal impairment
Rationale for FFP Use
- To restore hemostatic function by replacing depleted coagulation factors, thereby reducing the risk of anastomotic bleeding which could compromise surgical outcomes
- FFP contains all coagulation factors and can correct multiple factor deficiencies simultaneously
Important Considerations
- FFP should not be used for volume expansion or nutritional support, as more appropriate alternatives exist for these purposes 1
- The prophylactic use of FFP in elective cardiac surgery is not recommended, and its use should be based on documented coagulopathy or significant coagulation abnormalities 1
From the Research
FFP Transfusion in Post-Resection Anastomosis Case
- FFP transfusion is recommended in post-resection anastomosis cases with significant coagulopathy or bleeding complications 2, 3.
- The traditional approach to FFP transfusion suggests that it should be given based on laboratory or clinical evidence of coagulopathy or acute loss of 1 blood volume 4.
- However, some studies suggest that a more aggressive approach to FFP transfusion, with a ratio of FFP:platelet:erythrocyte approaching 1:1:1, may be beneficial in severe trauma cases 4.
- The use of FFP should be guided by the patient's clinical condition and laboratory results, rather than a fixed formula or ratio 5.
- FFP transfusion is definitely indicated in certain situations, such as replacement of single coagulation factor deficiencies, immediate reversal of warfarin effect, acute disseminated intravascular coagulation, and thrombotic thrombocytopenic purpura 5.
- In cardiovascular surgery, there is no evidence to support the prophylactic administration of FFP to patients without coagulopathy undergoing elective cardiac surgery 6.
- The decision to transfuse FFP should be made on a case-by-case basis, taking into account the patient's individual needs and the potential risks and benefits of transfusion 2, 3, 6, 5, 4.