Evans Christina R, Cuker Adam, Crowther Mark, Pishko Allyson M
Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA.
Department of Pathology and Laboratory Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA.
Res Pract Thromb Haemost. 2022 May 22;6(4):e12724. doi: 10.1002/rth2.12724. eCollection 2022 May.
The optimal prophylactic preprocedural management of patients with coagulopathy due to liver disease is not known.
Our objective was to compare the efficacy and safety of fresh frozen plasma (FFP) with prothrombin complex concentrate (PCC) in the preprocedural management of patients with coagulopathy of liver disease.
We conducted a systematic review to examine published evidence regarding treatment with FFP or PCC in adults with coagulopathy of liver disease undergoing an invasive procedure. Direct comparisons and single-arm studies were eligible. Efficacy outcomes included major bleeding, mortality, and correction of prothrombin time (PT) and/or international normalized ratio (INR). Safety outcomes included thrombosis and transfusion-related complications.
A total of 95 articles were identified for full-text review. Nine studies were eligible and included in the review. No randomized trials comparing FFP versus PCC were identified. Only two studies directly compared FFP versus PCC. In these studies, PCC appeared to result in higher rates of correction of PT/INR, but bleeding outcomes were not different. In the single-arm studies, bleeding events appeared low overall. Volume overload was the most common recorded adverse event in patients receiving FFP. Thromboembolic events occurred rarely, but exclusively in the PCC group. Due to heterogeneity in study definitions and bias, meta-analysis was not possible. Our study found no evidence to favor a specific product over another.
Insufficient data exist on the effects of FFP versus PCC administration before invasive procedures in patients with coagulopathy of liver disease to make conclusions with respect to relative efficacy or safety.
对于因肝病导致凝血功能障碍患者的最佳预防性术前管理尚不清楚。
我们的目的是比较新鲜冰冻血浆（FFP）与凝血酶原复合物浓缩剂（PCC）在肝病凝血功能障碍患者术前管理中的疗效和安全性。
我们进行了一项系统评价，以研究已发表的关于接受侵入性手术的肝病凝血功能障碍成年患者使用FFP或PCC治疗的证据。直接比较和单臂研究均符合条件。疗效结局包括大出血、死亡率以及凝血酶原时间（PT）和/或国际标准化比值（INR）的纠正情况。安全性结局包括血栓形成和输血相关并发症。
共筛选出95篇文章进行全文审查。9项研究符合条件并纳入本评价。未发现比较FFP与PCC的随机试验。仅两项研究直接比较了FFP与PCC。在这些研究中，PCC似乎能使PT/INR的纠正率更高，但出血结局并无差异。在单臂研究中，总体出血事件似乎较少。容量超负荷是接受FFP患者中记录最常见的不良事件。血栓栓塞事件很少发生，但仅在PCC组出现。由于研究定义和偏倚存在异质性，无法进行荟萃分析。我们的研究未发现证据支持某一特定产品优于另一产品。
关于肝病凝血功能障碍患者在侵入性手术前使用FFP与PCC的效果，现有数据不足，无法就相对疗效或安全性得出结论。
