Abstract
Objective
To evaluate the association between plasma transfusion and bleeding complications
in critically ill patients with an elevated international normalized ratios undergoing
invasive procedures.
Methods
A retrospective study was conducted to evaluate a consecutive sample of critically
ill adult patients undergoing invasive procedures (N = 487) with an international
normalized ratio ≥ 1.5 between January 1, 2019 and December 31, 2019. Among the followed
patients, 125 were excluded due to incomplete case records and 362 were finally included
in this investigation. The exposure was whether plasma had been transfused within
24 h before the invasive procedure. The primary outcome was the occurrence of postprocedural
bleeding complications. Secondary outcomes included transfusion of red blood cells
within 24 h of the invasive procedure, and additional patient-important outcomes such
as mortality and length of stay. Tests were performed with univariate and propensity-matched
analyses.
Results
Of the 362 study participants, 99 (27.3 %) received a preprocedural plasma transfusion.
In the propensity score-matched analysis, the rate of the occurrence of postprocedural
bleeding complications between two groups was not statistically different (OR, 0.605[95
% CI, 0.341–1.071]; P = .085). The rate of postoperative red blood cell transfusion in the plasma transfusion
group was higher than that in the non-plasma transfusion group (35.5 % vs 21.5 %;
P < .05). No statistically significant difference in mortality was observed between
the two groups (29.0 % vs 31.6 %; P = .101).
Conclusions
Prophylactic plasma transfusion failed to reduce postprocedural bleeding complications
in ill critically patients with a coagulopathy. Meanwhile, it was associated with
increased red blood cell transfusion after invasive procedures. Findings suggest that
abnormal preprocedural international normalized ratios should be managed more conservatively.
Keywords
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Article info
Publication history
Published online: March 11, 2023
Accepted:
March 10,
2023
Received in revised form:
March 2,
2023
Received:
September 2,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
