TY - JOUR
T1 - Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients
AU - Hinton, Jake V.
AU - Fletcher, Calvin M.
AU - Perry, Luke A.
AU - Greifer, Noah
AU - Hinton, Jessica N.
AU - Williams-Spence, Jenni
AU - Segal, Reny
AU - Smith, Julian A.
AU - Reid, Christopher M.
AU - Weinberg, Laurence
AU - Bellomo, Rinaldo
N1 - Funding Information:
The ANZSCTS Database thanks all of the investigators, data managers, and institutions that participate in the Program.
Publisher Copyright:
Copyright: © 2024 Hinton et al.
PY - 2024/1
Y1 - 2024/1
N2 - Platelets (PLTS) and fresh frozen plasma (FFP) are often transfused in cardiac surgery patients for perioperative bleeding. Their relative effectiveness is unknown. Methods We 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. Results Of 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; P<0.001) and 1-year (RR, 1.50; 95% CI, 1.32 to 1.71; P<0.001) mortality. FFP was associated with increased rates of 4-hour chest drain tube output (Adjusted mean difference in ml, 28.37; 95% CI, 19.35 to 37.38; P<0.001), AKI (RR, 1.13; 95% CI, 1.01 to 1.27; P = 0.033) and readmission to ICU (RR, 1.24; 95% CI, 1.09 to 1.42; P = 0.001). Conclusion In 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 pro-coagulant therapy in this setting.
AB - Platelets (PLTS) and fresh frozen plasma (FFP) are often transfused in cardiac surgery patients for perioperative bleeding. Their relative effectiveness is unknown. Methods We 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. Results Of 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; P<0.001) and 1-year (RR, 1.50; 95% CI, 1.32 to 1.71; P<0.001) mortality. FFP was associated with increased rates of 4-hour chest drain tube output (Adjusted mean difference in ml, 28.37; 95% CI, 19.35 to 37.38; P<0.001), AKI (RR, 1.13; 95% CI, 1.01 to 1.27; P = 0.033) and readmission to ICU (RR, 1.24; 95% CI, 1.09 to 1.42; P = 0.001). Conclusion In 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 pro-coagulant therapy in this setting.
UR - http://www.scopus.com/inward/record.url?scp=85182789526&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0296726
DO - 10.1371/journal.pone.0296726
M3 - Article
C2 - 38232077
AN - SCOPUS:85182789526
SN - 1932-6203
VL - 19
JO - PLoS ONE
JF - PLoS ONE
IS - 1
M1 - e0296726
ER -