PLoS ONE (Jan 2024)

Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients.

  • Jake V Hinton,
  • Calvin M Fletcher,
  • Luke A Perry,
  • Noah Greifer,
  • Jessica N Hinton,
  • Jenni Williams-Spence,
  • Reny Segal,
  • Julian A Smith,
  • Christopher M Reid,
  • Laurence Weinberg,
  • Rinaldo Bellomo

DOI
https://doi.org/10.1371/journal.pone.0296726
Journal volume & issue
Vol. 19, no. 1
p. e0296726

Abstract

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BackgroundPlatelets (PLTS) and fresh frozen plasma (FFP) are often transfused in cardiac surgery patients for perioperative bleeding. Their relative effectiveness is unknown.MethodsWe conducted an entropy-weighted retrospective cohort study using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. All adults undergoing cardiac surgery between 2005-2021 across 58 sites were included. The primary outcome was operative mortality.ResultsOf 174,796 eligible patients, 15,360 (8.79%) received PLTS in the absence of FFP and 6,189 (3.54%) patients received FFP in the absence of PLTS. The median cumulative dose was 1 unit of pooled platelets (IQR 1 to 3) and 2 units of FFP (IQR 0 to 4) respectively. After entropy weighting to achieve balanced cohorts, FFP was associated with increased perioperative (Risk Ratio [RR], 1.63; 95% Confidence Interval [CI], 1.40 to 1.91; PConclusionIn perioperative bleeding in cardiac surgery patient, platelets are associated with a relative mortality benefit over FFP. This information can be used by clinicians in their choice of procoagulant therapy in this setting.