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Prophylactic Plasma Transfusion Before Interventional Radiology Procedures Is Not Associated With Reduced Bleeding Complications

      Abstract

      Objective

      To determine the association between prophylactic plasma transfusion and periprocedural red blood cell (RBC) transfusion rates in patients with elevated international normalized ratio (INR) values undergoing interventional radiology procedures.

      Patients and Methods

      In this retrospective cohort study, adult patients undergoing interventional radiology procedures with a preprocedural INR available within 30 days of the procedure during a study period of January 1, 2009, to December 31, 2013, were eligible for inclusion. Baseline characteristics, coagulation parameters, transfusion requirements, and procedural details were extracted. Univariate and multivariable propensity-matched analyses were used to assess the relationships between prophylactic plasma transfusion and the outcomes of interest, with a primary outcome assessed a priori of RBC transfusion occurring during the procedure or within the first 24 hours postprocedurally.

      Results

      A total of 18,204 study participants met inclusion criteria for this study, and 1803 (9.9%) had an INR of 1.5 or greater before their procedure. Of these 1803 patients, 196 patients (10.9%) received prophylactic plasma transfusion with a median time of 1.9 hours (interquartile range [IQR], 1.1-3.2 hours) between plasma transfusion initiation and procedure initiation. In multivariable propensity-matched analysis, plasma administration was associated with increased periprocedural RBC transfusions (odds ratio, 2.20; 95% CI, 1.38-3.50; P<.001) and postprocedural intensive care unit admission rates (odds ratio, 2.11; 95% CI, 1.41-3.14; P<.001) as compared with those who were not transfused preprocedurally. Similar relationships were seen at higher INR thresholds for plasma transfusion.

      Conclusion

      In patients undergoing interventional radiology procedures, preprocedural plasma transfusions given in the setting of elevated INR values were associated with increased periprocedural RBC transfusions. Additional research is needed to clarify this potential association between preprocedural plasma transfusion and periprocedural RBC transfusion.

      Abbreviations and Acronyms:

      ICU (intensive care unit), INR (international normalized ratio), IQR (interquartile range), OR (odds ratio), RBC (red blood cell)
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      References

        • Patel I.J.
        • Davidson J.C.
        • Nikolic B.
        • et al.
        • Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement
        Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions.
        J Vasc Interv Radiol. 2012; 23: 727-736
        • US Department of Health and Human Services
        The 2011 National Blood Collection and Utilization Survey.
        US Department of Health and Human Services, Washington, DC2011
        • Holland L.L.
        • Foster T.M.
        • Marlar R.A.
        • Brooks J.P.
        Fresh frozen plasma is ineffective for correcting minimally elevated international normalized ratios.
        Transfusion. 2005; 45: 1234-1235
        • Vlaar A.P.
        • in der Maur A.L.
        • Binnekade J.M.
        • Schultz M.J.
        • Juffermans N.P.
        A survey of physicians' reasons to transfuse plasma and platelets in the critically ill: a prospective single-centre cohort study.
        Transfus Med. 2009; 19: 207-212
        • Lauzier F.
        • Cook D.
        • Griffith L.
        • Upton J.
        • Crowther M.
        Fresh frozen plasma transfusion in critically ill patients.
        Crit Care Med. 2007; 35: 1655-1659
        • Dzik W.H.
        Predicting hemorrhage using preoperative coagulation screening assays.
        Curr Hematol Rep. 2004; 3: 324-330
        • Kor D.J.
        • Gajic O.
        Blood product transfusion in the critical care setting.
        Curr Opin Crit Care. 2010; 16: 309-316
        • Segal J.B.
        • Dzik W.H.
        • Transfusion Medicine/Hemostasis Clinical Trials Network
        Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review.
        Transfusion. 2005; 45: 1413-1425
        • Stanworth S.J.
        • Brunskill S.J.
        • Hyde C.J.
        • McClelland D.B.
        • Murphy M.F.
        Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials.
        Br J Haematol. 2004; 126: 139-152
        • Holland L.L.
        • Brooks J.P.
        Toward rational fresh frozen plasma transfusion: the effect of plasma transfusion on coagulation test results.
        Am J Clin Pathol. 2006; 126: 133-139
        • Abdel-Wahab O.I.
        • Healy B.
        • Dzik W.H.
        Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities.
        Transfusion. 2006; 46: 1279-1285
        • Müller M.C.
        • Arbous M.S.
        • Spoelstra-de Man A.M.
        • et al.
        Transfusion of fresh-frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial (CME).
        Transfusion. 2015; 55 (quiz 25): 26-35
        • Darcy M.D.
        • Kanterman R.Y.
        • Kleinhoffer M.A.
        • et al.
        Evaluation of coagulation tests as predictors of angiographic bleeding complications.
        Radiology. 1996; 198: 741-744
        • Ewe K.
        Bleeding after liver biopsy does not correlate with indices of peripheral coagulation.
        Dig Dis Sci. 1981; 26: 388-393
        • Doerfler M.E.
        • Kaufman B.
        • Goldenberg A.S.
        Central venous catheter placement in patients with disorders of hemostasis.
        Chest. 1996; 110: 185-188
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        • STROBE Initiative
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • Herasevich V.
        • Kor D.J.
        • Li M.
        • Pickering B.W.
        ICU data mart: a non-iT approach. A team of clinicians, researchers and informatics personnel at the Mayo Clinic have taken a homegrown approach to building an ICU data mart.
        Healthc Inform. 2011; 28(11): 44-45
        • Chute C.G.
        • Beck S.A.
        • Fisk T.B.
        • Mohr D.N.
        The Enterprise Data Trust at Mayo Clinic: a semantically integrated warehouse of biomedical data.
        J Am Med Inform Assoc. 2010; 17: 131-135
        • Singh B.
        • Singh A.
        • Ahmed A.
        • et al.
        Derivation and validation of automated electronic search strategies to extract Charlson comorbidities from electronic medical records.
        Mayo Clin Proc. 2012; 87: 817-824
        • Qian F.
        • Osler T.M.
        • Eaton M.P.
        • et al.
        Variation of blood transfusion in patients undergoing major noncardiac surgery.
        Ann Surg. 2013; 257: 266-278
        • Bergstralh E.J.
        • Kosanke J.L.
        • Jacobsen S.J.
        Software for optimal matching in observational studies.
        Epidemiology. 1996; 7: 331-332
        • Fisher N.C.
        • Mutimer D.J.
        Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit.
        Intensive Care Med. 1999; 25: 481-485
        • Tercan F.
        • Ozkan U.
        • Oguzkurt L.
        US-guided placement of central vein catheters in patients with disorders of hemostasis.
        Eur J Radiol. 2008; 65: 253-256
        • Della Vigna P.
        • Monfardini L.
        • Bonomo G.
        • et al.
        Coagulation disorders in patients with cancer: nontunneled central venous catheter placement with US guidance—a single-institution retrospective analysis.
        Radiology. 2009; 253: 249-252
        • Stecker M.S.
        • Johnson M.S.
        • Ying J.
        • et al.
        Time to hemostasis after traction removal of tunneled cuffed central venous catheters.
        J Vasc Interv Radiol. 2007; 18 (quiz 1240): 1232-1239
        • Martin J.H.
        • Rosser C.J.
        • Linebach R.F.
        • McCullough D.L.
        • Assimos D.G.
        Are coagulation studies necessary before percutaneous nephrostomy?.
        Tech Urol. 2000; 6: 205-207
        • Zagoria R.J.
        • Dyer R.B.
        Do's and don't's of percutaneous nephrostomy.
        Acad Radiol. 1999; 6: 370-377
        • Ansell J.
        • Hirsh J.
        • Hylek E.
        • Jacobson A.
        • Crowther M.
        • Palareti G.
        • American College of Chest Physicians
        Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).
        Chest. 2008; 133: 160S-198S
        • Teixeira P.G.
        • Inaba K.
        • Shulman I.
        • et al.
        Impact of plasma transfusion in massively transfused trauma patients.
        J Trauma. 2009; 66: 693-697
        • Villanueva C.
        • Colomo A.
        • Bosch A.
        • et al.
        Transfusion strategies for acute upper gastrointestinal bleeding.
        N Engl J Med. 2013; 368 ([published correction appears in N Engl J Med. 2013;368(24):2341]): 11-21
        • Müller M.C.
        • Straat M.
        • Meijers J.C.
        • et al.
        Fresh frozen plasma transfusion fails to influence the hemostatic balance in critically ill patients with a coagulopathy.
        J Thromb Haemost. 2015; 13: 989-997