Recommended Dosage of Fresh Frozen Plasma (FFP) for Elevated INR
For patients requiring FFP transfusion, the recommended dose is 10-15 mL/kg, which typically corresponds to 3-6 units in an average adult. 1
Indications for FFP Transfusion
- FFP should not be used routinely for mild to moderate coagulation abnormalities, as it often fails to normalize INR values in patients with mild elevations (INR <2.0) 2
- FFP transfusion is indicated primarily in the following scenarios:
Dosing Considerations
- The effect of FFP on INR correction is directly related to the pre-transfusion INR value 4
- For patients with minimally elevated INR (<1.6), FFP transfusion provides minimal benefit and exposes patients to unnecessary risks 4
- The change in INR per unit of FFP can be predicted by the formula: INR change = 0.37 × (pretransfusion INR) - 0.47 4
- Significant INR improvement typically requires at least 6 units of FFP, particularly in patients with liver disease 5
Preferred Alternatives to FFP
- Prothrombin Complex Concentrate (PCC) is the preferred first-line treatment for urgent reversal of anticoagulation rather than FFP 1
- Four-factor PCC is recommended at a dose of 25-50 U/kg based on INR level and body weight 3
- When using PCC, co-administration of 5-10 mg vitamin K is recommended to sustain the reversal effect 3
Special Clinical Scenarios
- For patients with liver disease, FFP has even less effect on INR correction and should be avoided unless there is active bleeding 1
- In trauma patients requiring massive transfusion, a high FFP:PRBC ratio decreases mortality regardless of admission INR 6
- For intracranial hemorrhage with elevated INR, rapid normalization of coagulation status is mandatory to prevent hematoma expansion 7
Monitoring After FFP Administration
- Repeat INR testing should be performed 15-60 minutes after FFP administration in urgent situations 1
- Serial INR monitoring every 6-8 hours for 24-48 hours is recommended if reversal was performed 1
Risks of FFP Transfusion
- FFP transfusion carries significant risks including:
Common Pitfalls to Avoid
- Prophylactic FFP transfusion for mildly elevated INR (1.1-1.85) is ineffective, as it normalizes INR in only 0.8% of patients 2
- Delaying urgent procedures while waiting for FFP administration in patients with only mildly elevated INR provides no benefit and may cause harm 8
- Using FFP alone without vitamin K in patients on warfarin provides only temporary correction 3