This work is a post hoc analysis of a randomised controlled clinical trial in which the authors evaluated the efficacy and safety of prophylactic fresh frozen plasma (FFP) transfusion in critically ill patients with a coagulopathy (INR 1.5-3.0) but without active bleeding. No difference in bleeding complications was observed, whether FFP was prophylactically administered or not (Müller MC et al. Transfusion 2015;55:26-35).
This post hoc study may provide the explanation for these results. Indeed, the authors observed a significant increase in levels of factor II, factor V, factor VII and anticoagulant proteins after transfusion of 12 mL/kg of FFP, but FFP transfusion did not significantly affect thrombin generation or thromboelastrometry.
These results suggest that there is no indication to transfuse FFP prophylactically in intensive care patients who have a prolonged INR before an invasive procedure, as frequently reported in clinical practice.
– Michael Piagnerelli