Review
Clinical review: Fresh frozen plasma in massive bleedings - more questions than answers
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* Corresponding author: Sandro Rizoli sandro.rizoli@sunnybrook.ca
1 Transfusion Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, C160, Toronto, ON M4N 3M5, Canada
2 Pathobiology and Laboratory Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, B204, Toronto, ON M4N 3M5, Canada
3 Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, D503, Toronto, ON M4N 3M5, Canada
4 Department of Surgery, Universidade Federal de Minas Gerais, Ave Alfredo Balena 190, Belo Horizonte, Minas Gerais 30-130-100, Brazil
5 Surgery and Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, H171, Toronto, ON M4N 3M5, Canada
Critical Care 2010, 14:202 doi:10.1186/cc8205
Published: 28 January 2010Abstract
Fresh frozen plasma (FFP) is indicated for the management of massive bleedings. Recent audits suggest physician knowledge of FFP is inadequate and half of the FFP transfused in critical care is inappropriate. Trauma is among the largest consumers of FFP. Current trauma resuscitation guidelines recommend FFP to correct coagulopathy only after diagnosed by laboratory tests, often when overt dilutional coagulopathy already exists. The evidence supporting these guidelines is limited and bleeding remains a major cause of trauma-related death. Recent studies demonstrated that coagulopathy occurs early in trauma. A novel early formula-driven haemostatic resuscitation proposes addressing coagulopathy early in massive bleedings with FFP at a near 1:1 ratio with red blood cells. Recent retrospective reports suggest such strategy significantly reduces mortality, and its use is gradually expanding to nontraumatic bleedings in critical care. The supporting studies, however, have bias limiting the interpretation of the results. Furthermore, logistical considerations including need for immediately available universal donor AB plasma, short life after thawing, potential waste and transfusion-associated complications have challenged its implementation. The present review focuses on FFP transfusion in massive bleeding and critically appraises the evidence on formula-driven resuscitation, providing resources to allow clinicians to develop informed opinion, given the current deficient and conflicting evidence.