Department of Anesthesiology/Division of Critical Care Medicine Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Best Pract Res Clin Anaesthesiol. 2010 Mar;24(1):51-64. doi: 10.1016/j.bpa.2009.09.007.
Clinical studies support the use of perioperative fresh frozen plasma (FFP) in patients who are actively bleeding with multiple coagulation factor deficiencies and for the prevention of dilutional coagulopathy in patients with major trauma and/or massive haemorrhage. In these settings, current FFP dosing recommendations may be inadequate. However, a substantial proportion of FFP is transfused in non-bleeding patients with mild elevations in coagulation screening tests. This practice is not supported by the literature, is unlikely to be of benefit and unnecessarily exposes patients to the risks of FFP. The role of FFP in reversing the effects of warfarin anticoagulation is dependent on the clinical context and availability of alternative agents. Although FFP is commonly transfused in patients with liver disease, this practice needs broad reconsideration. Adverse effects of FFP include febrile and allergic reactions, transfusion-associated circulatory overload and transfusion-related acute lung injury. The latter is the most serious complication, being less common with the preferential use of non-alloimmunised, male-donor predominant plasma. FP24 and thawed plasma are alternatives to FFP with similar indications for administration. Both provide an opportunity for increasing the safe plasma donor pool. Although prothrombin complex concentrates and factor VIIa may be used as alternatives to FFP in a variety of specific clinical contexts, additional study is needed.
临床研究支持在有多种凝血因子缺乏且 actively bleeding 的患者中使用围手术期新鲜冷冻血浆（FFP），并在有重大创伤和/或大量出血的患者中预防稀释性凝血障碍。在这些情况下，目前的 FFP 剂量推荐可能不足。然而，大量的 FFP 被输注给有轻微凝血筛选试验升高的非出血患者。这种做法没有文献支持，不太可能有益，并且会不必要地使患者面临 FFP 的风险。FFP 在逆转华法林抗凝作用中的作用取决于临床情况和替代药物的可用性。尽管 FFP 在肝病患者中经常被输注，但这种做法需要广泛重新考虑。FFP 的不良反应包括发热和过敏反应、输血相关循环超负荷和输血相关急性肺损伤。后者是最严重的并发症，优先使用非同种免疫、男性供体为主的血浆时较少发生。FP24 和解冻的血浆是 FFP 的替代品，具有相似的给药适应症。两者都为增加安全的血浆供体池提供了机会。尽管凝血酶原复合物浓缩物和因子 VIIa 可在各种特定的临床情况下替代 FFP 使用，但仍需要进一步研究。
