Zander Ashley L, Olson Erik J, Van Gent Jan-Michael, Bandle Jesse, Calvo Richard Y, Shackford Steven R, Peck Kimberly A, Sise C Beth, Sise Michael J, King Bryan S
From the Trauma Service, Scripps Mercy Hospital, San Diego, California.
J Trauma Acute Care Surg. 2015 Jan;78(1):39-43; discussion 43-4. doi: 10.1097/TA.0000000000000480.
Resuscitation with blood products improves survival in patients with traumatic hemorrhage. However, the risk of venous thromboembolic (VTE) complications associated with fresh frozen plasma (FFP) resuscitation is unknown. We hypothesized that a higher ratio of FFP to packed red blood cells (PRBCs) given during acute resuscitation increases the risk of VTE independent of severity of injury and shock.
The records of patients admitted from April 2007 to December 2011 who had surveillance lower extremity duplex ultrasounds were retrospectively reviewed. Patients who received at least 1 U of PRBCs within 24 hours of admission were included. Patients who died without VTE were excluded. The relationship between FFP and VTE was evaluated using logistic regression.
A total of 381 patients met inclusion criteria, of whom 77 (20.2%) developed VTE. In patients who required less than 4 U of PRBCs, increasing units of FFP were associated with an increasing risk for VTE, with each unit of FFP having an adjusted odds ratio of 1.27 (95% confidence interval, 1.04-1.54, p = 0.015). Conversely, in patients who required four or greater units of PRBCs, FFP in equal or greater ratios than PRBCs was not associated with VTE.
Each unit of FFP increased VTE risk by 25% in patients who required less than 4 U of PRBCs. In patients who required 4 U or greater PRBCs, FFP administration conferred no increased risk of VTE. This suggests that FFP should be used cautiously when early hemodynamic stability can be achieved with less than 4 U of PRBCs.
Care management study, level III.
使用血液制品进行复苏可提高创伤性出血患者的生存率。然而，与新鲜冰冻血浆（FFP）复苏相关的静脉血栓栓塞（VTE）并发症风险尚不清楚。我们假设，在急性复苏期间给予的FFP与浓缩红细胞（PRBCs）的比例越高，VTE风险就越高，且与损伤和休克的严重程度无关。
回顾性分析2007年4月至2011年12月入院并接受下肢双功超声监测的患者记录。纳入入院后24小时内接受至少1单位PRBCs的患者。排除无VTE死亡的患者。使用逻辑回归评估FFP与VTE之间的关系。
共有381例患者符合纳入标准，其中77例（20.2%）发生VTE。在需要少于4单位PRBCs的患者中，FFP单位数增加与VTE风险增加相关，每单位FFP的调整优势比为1.27（95%置信区间，1.04 - 1.54，p = 0.015）。相反，在需要4单位或更多PRBCs的患者中，FFP与PRBCs比例相等或更高时与VTE无关。
在需要少于4单位PRBCs的患者中，每单位FFP使VTE风险增加25%。在需要4单位或更多PRBCs的患者中，给予FFP不会增加VTE风险。这表明，当使用少于4单位PRBCs即可实现早期血流动力学稳定时，应谨慎使用FFP。
护理管理研究，III级。
