Scheiderer Ashley N, Shachner Tracy R, Rains Anna W, Heidel Robert E, Clark Christopher T
The University of Tennessee Medical Center, Knoxville, TN, United States.
The University of Tennessee Medical Center, Knoxville, TN, United States.
Hematol Transfus Cell Ther. 2023 Jan-Mar;45(1):1-6. doi: 10.1016/j.htct.2021.01.015. Epub 2021 May 4.
Plasma transfusion is a common therapeutic strategy used to lower international normalized ratio (INR) values in the non-emergent setting. However, due to lack of evidence of its efficacy, standardized guidelines for this practice have not been well established.
This retrospective observational cohort study analyzed 276 inpatient encounters that involved plasma transfusions focusing on change in INR values from pre- to post-transfusion, with respect to the following predictor variables: vitamin K co-administration, number of plasma units transfused, order indication and body mass index (BMI).
The overall average change in the INR was 1.35. Patients who received vitamin K showed an average change of 2.51, while patients that did not receive vitamin K demonstrated an average change of 0.70. Increased numbers of plasma units transfused showed benefit up to three-unit orders. Greater decreases in the INR were observed for patients requiring plasma for anticoagulation reversal or active bleeding. There was no significant difference in the change in INR based on the BMI. By multivariate and regression analyses, the stepwise addition of each successive predictor variable demonstrated an increase in the shared variance in the outcome of the post-transfusion INR: the pre-transfusion INR and vitamin K co-administration alone was not significant (p = 0.45); the additional number of plasma units transfused was significant (R² = 0.13, p < 0.001), and; the subsequent additional plasma order indications (R² = 0.19, p < 0.001) and BMI (R² = 0.18, p < 0.001) were increasingly significant.
Taking into consideration the combination of multiple predictive factors may aid in a more efficient use of plasma products.
血浆输注是一种在非紧急情况下用于降低国际标准化比值（INR）的常见治疗策略。然而，由于缺乏其疗效的证据，该操作的标准化指南尚未完善确立。
这项回顾性观察性队列研究分析了276例涉及血浆输注的住院病例，重点关注输血前后INR值的变化，并考虑以下预测变量：维生素K联合使用情况、输注的血浆单位数量、医嘱指征和体重指数（BMI）。
INR的总体平均变化为1.35。接受维生素K的患者平均变化为2.51，而未接受维生素K的患者平均变化为0.70。输注血浆单位数量增加显示出直至三个单位医嘱量的益处。对于因抗凝逆转或活动性出血而需要血浆的患者，INR下降幅度更大。基于BMI的INR变化无显著差异。通过多变量和回归分析，逐步添加每个连续的预测变量显示输血后INR结果的共享方差增加：仅输血前INR和维生素K联合使用不显著（p = 0.45）；输注的额外血浆单位数量显著（R² = 0.13，p < 0.001），并且；随后额外的血浆医嘱指征（R² = 0.19，p < 0.001）和BMI（R² = 0.18，p < 0.001）越来越显著。
考虑多种预测因素的组合可能有助于更有效地使用血浆制品。
