From the Guidelines
Fresh frozen plasma (FFP) should be transfused in patients with active bleeding and coagulopathy, such as those with an INR > 1.5, or in patients with acute disseminated intravascular coagulation (DIC) with bleeding, as indicated by the most recent guidelines 1. The main indications for FFP transfusion include:
- Replacement of coagulation factors during major hemorrhage, particularly trauma and obstetrics
- Acute disseminated intravascular coagulation (DIC) with bleeding
- Patients who are actively bleeding and whose INR is > 1.5 (or POC equivalent)
- Immediate reversal of warfarin-induced hemorrhage when prothrombin complex concentrates are not available
- Thrombocytopenic purpura, usually with plasmapheresis, preferably using pathogen-inactivated FFP The typical dose of FFP is 10-15 mL/kg body weight, with each unit containing approximately 200-250 mL, as recommended by previous guidelines 1. However, the use of FFP in patients with cirrhosis or liver disease is limited, and it should not be used simply as routine circulatory volume replacement or for mild coagulation abnormalities, as stated in the most recent guidelines 1 and supported by more recent studies 1. It is essential to note that FFP should be ABO-compatible with the recipient, and administration should begin within 24 hours of thawing. The use of FFP should be guided by the most recent and highest-quality evidence, prioritizing patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Indications for Transfusing Fresh Frozen Plasma
- Fresh frozen plasma (FFP) is often used to correct coagulopathy in patients with liver disease or other bleeding disorders 2, 3, 4, 5, 6
- The efficacy of FFP in enhancing thrombin generation and correcting coagulopathy has been questioned, with some studies suggesting that it may only slightly improve coagulation test values in a limited number of patients 2, 5
- FFP transfusion has been associated with inherent risks and costs, including volume overload and transfusion-related complications 3, 5, 6
Patient Populations
- Patients with cirrhosis and coagulopathy may not benefit from FFP transfusion, as it may only slightly improve coagulation test values and even worsen them in some cases 2
- Critically ill medical patients with coagulopathy may not have a favorable risk-benefit ratio for FFP transfusion, with no difference in hospital mortality and intensive care unit length of stay among survivors 3
- Patients with mild coagulation abnormalities may not require FFP transfusion, as it may not correct the coagulopathy and may be associated with adverse events 5
Alternative Therapies
- Prothrombin complex concentrates (PCCs) and recombinant factor VIIa (rFVIIa) may be effective alternatives to FFP for facilitating procedures in critically ill patients with coagulopathy from liver disease 4, 6
- PCCs and rFVIIa may be more effective than FFP in lowering international normalized ratio (INR) and facilitating procedures, with a lower risk of hypervolemia and adverse events 6