Hemostatic Effects of Fresh Frozen Plasma May be Maximal at Red Cell Ratios of 1:2
Hemostatic Effects of Fresh Frozen Plasma May be Maximal at Red Cell Ratios of 1:2
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DOI：
10.1097/ta.0b013e318202e486
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发表时间：
2011-01-01
影响因子：
--
通讯作者：
Brohi, Karim
中科院分区：
文献类型：
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作者：
Davenport, Ross;Curry, Nicola;Brohi, Karim
背景：早期给予大剂量新鲜冰冻血浆（FFP），损伤控制复苏的目标是急性创伤性凝血病。FFP凭经验给药，并与压积红细胞（PRBC）的数量成比例。关于结局的最佳FFP：PRBC比例存在争议，并且尚未研究其止血效果。我们报告了不同FFP：PRBC比例对凝血功能的影响的初步结果。方法：这是一项对需要>4 U PRBC的创伤患者进行的前瞻性观察性队列研究。在每个4-U PRBC间隔之前和之后抽取血液用于凝血酶原时间和通过旋转血栓弹性测定法分析。凝血参数的间隔变化进行了比较与FFP：PRBC的比率在每个interval.Results：60个4-U PRBC的50例患者的时间间隔可用于分析。低FFP：PRBC比率（= 1：1比率）时，所有凝血指标均恶化，未带来任何额外改善。对FFP的反应存在明显的变异性，并且在暴露于1：1比例的一些患者中止血功能恶化。血浆的有益作用仅限于凝血病患者。结论：这项前瞻性研究的中期结果表明，FFP：PRBC比率>= 1：1并没有赋予任何额外的优势比1：2至3：4。血浆治疗的止血获益仅限于凝血病患者。
Background: Damage control resuscitation targets acute traumatic coagulopathy with the early administration of high-dose fresh frozen plasma (FFP). FFP is administered empirically and as a ratio with the number of packed red blood cells (PRBC). There is controversy over the optimal FFP: PRBC ratio with respect to outcomes, and their hemostatic effects have not been studied. We report preliminary findings on the effects of different FFP: PRBC ratios on coagulation.Methods: This is a prospective observational cohort study of trauma patients requiring >4 U of PRBCs. Blood was drawn before and after each 4-U PRBC interval for prothrombin time and analysis by rotational thromboelastometry. Interval change in coagulation parameters were compared with the FFP: PRBC ratio received during each interval.Results: Sixty 4-U PRBC intervals from 50 patients were available for analysis. All measures of coagulation deteriorated with low FFP: PRBC ratios (= 1:1 ratio did not confer any additional improvement. There was a marked variability in response to FFP, and hemostatic function deteriorated in some patients exposed to 1:1 ratios. The beneficial effects of plasma were confined to patients with coagulopathy.Conclusions: Interim results from this prospective study suggest that FFP: PRBC ratios of >= 1:1 do not confer any additional advantage over ratios of 1:2 to 3:4. Hemostatic benefits of plasma therapy are limited to patients with coagulopathy.