Youssef Wael I, Salazar Fernando, Dasarathy Srinivasan, Beddow Timothy, Mullen Kevin Daniel
Division of Gastroenterology, Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
Am J Gastroenterol. 2003 Jun;98(6):1391-4. doi: 10.1111/j.1572-0241.2003.07467.x.
Fresh frozen plasma infusions are commonly used to correct the prolonged prothrombin time in patients with advanced chronic liver disease. The aim of this study was to establish how frequently this treatment is effective in correcting this coagulopathy.
A split retrospective-prospective study design was employed. In the retrospective series, 80 patients were identified with prolongation of the prothrombin time who received fresh frozen plasma infusions. In the prospective arm, 20 patients were included. All patients had confirmed chronic liver disease and showed no response to vitamin K injections. None of the patients had evidence of disseminated intravascular coagulation. The indications for infusion of fresh frozen plasma, number of units administered, complications, and percentage of patients who corrected their prothrombin time to less than 3 s longer than control time were recorded.
The majority of patients (75%) received 2-4 units of fresh frozen plasma. The mean prothrombin time was numerically improved by the infusion of 2-6 units of fresh frozen plasma. However, using correction to less than 3 s longer than control time as an endpoint, only 12.5% of the retrospective and 10% of the prospective study groups respectively had correction of their coagulopathy. Only one complication of infusion of plasma was noted during the course of the study.
Our results reiterate previous observations made more than 45 yr ago, that fresh frozen plasma infusions using the number of units commonly employed in clinical practice infrequently correct the coagulopathy of patients with chronic liver disease. Higher volumes (6 or more units) may be more effective but are rarely employed.
新鲜冰冻血浆输注常用于纠正晚期慢性肝病患者延长的凝血酶原时间。本研究的目的是确定这种治疗纠正这种凝血病的频率。
采用回顾性与前瞻性相结合的研究设计。在回顾性系列中，确定了80例接受新鲜冰冻血浆输注且凝血酶原时间延长的患者。在前瞻性队列中，纳入了20例患者。所有患者均确诊为慢性肝病，且对维生素K注射无反应。所有患者均无弥散性血管内凝血的证据。记录新鲜冰冻血浆输注的指征、输注单位数、并发症以及凝血酶原时间纠正至比对照时间长不到3秒的患者百分比。
大多数患者（75%）接受了2 - 4单位的新鲜冰冻血浆。输注2 - 6单位新鲜冰冻血浆后，凝血酶原时间在数值上有所改善。然而，以纠正至比对照时间长不到3秒作为终点，回顾性研究组和前瞻性研究组分别仅有12.5%和10%的患者凝血病得到纠正。在研究过程中，仅记录到1例血浆输注并发症。
我们的结果重申了45年多前所做的观察，即临床实践中常用单位数量的新鲜冰冻血浆输注很少能纠正慢性肝病患者的凝血病。更大剂量（6单位或更多）可能更有效，但很少使用。
