From the Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Periprocedural Outcomes, Information and Transfusion Study Group, Mayo Clinic, Rochester, Minnesota.
Anesth Analg. 2018 Aug;127(2):349-357. doi: 10.1213/ANE.0000000000003336.
Plasma transfusion is commonly performed for the correction of abnormal coagulation screening tests. The goal of this investigation was to assess the relationship between the dose of plasma administered and changes in coagulation test results in a large and diverse cohort of patients with varying levels of coagulation abnormalities and comorbid disease and in a variety of clinical settings.
In this single-center historical cohort study, all plasma transfusion episodes in adult patients with abnormal coagulation screening tests were extracted between 2011 and 2015. The primary outcome was the proportion of patients attaining normal posttransfusion international normalized ratio (INR ≤ 1.1) with secondary outcomes including the proportion of patients attaining partial normalization of INR (INR ≤ 1.5) or at least 50% normalization in pretransfusion values with respect to an INR of 1.1.
In total, 6779 unique patients received plasma with a median (quartiles) pretransfusion INR of 1.9 (1.6-2.5) and a median transfusion volume of 2 (2-3) units. The majority (85%) of transfusions occurred perioperatively, with 20% of transfusions administered prophylactically before a procedure. The median decrease in INR was 0.4 (0.2-0.8). Complete INR normalization was obtained in 12%. Reductions in INR were modest with pretransfusion INR values <3. Patients receiving ≥3 units of plasma were more likely to achieve at least 50% normalization in INR than those receiving ≤2 units (68% vs 60%; P < .001).
Changes in INR after plasma transfusion were modest at typically used clinical doses, particularly in those with less severely deranged baseline coagulation screening tests. Further studies are necessary to assess the relationships between plasma-mediated changes in INR and clinical outcomes.
常通过输注血浆来纠正异常的凝血筛选试验。本研究旨在评估在一个大的、不同的患者群体中，输注不同剂量的血浆与凝血试验结果变化之间的关系，该患者群体具有不同程度的凝血异常和合并症，并处于多种临床环境中。
在这项单中心的历史队列研究中，从 2011 年至 2015 年提取了所有具有异常凝血筛选试验的成年患者的血浆输注病例。主要结局是达到正常输注后国际标准化比值（INR≤1.1）的患者比例，次要结局包括达到 INR 部分正常（INR≤1.5）或相对于 INR 为 1.1 至少有 50%的正常化的患者比例。
共 6779 例患者输注了血浆，中位数（四分位距）输注前 INR 为 1.9（1.6-2.5），中位数输注量为 2（2-3）单位。大多数（85%）输注发生在围手术期，其中 20%的输注是在手术前预防性进行的。INR 中位数降低 0.4（0.2-0.8）。完全 INR 正常化的比例为 12%。INR 降低幅度适度，输注前 INR 值<3。接受≥3 单位血浆的患者与接受≤2 单位的患者相比，INR 至少有 50%正常化的可能性更大（68% vs 60%；P<0.001）。
在典型的临床剂量下，输注血浆后 INR 的变化幅度适中，尤其是在基线凝血筛选试验异常程度较轻的患者中。需要进一步研究以评估 INR 与临床结局之间的关系。
