Does Autologous Fresh Frozen Plasma Reduce Blood Loss during Bypass Surgery? Kasper et al. (page 81)
Although other studies have not shown any benefit from prophylactic transfusion of fresh frozen plasma (FFP), Kasper et al. designed a study to test whether a therapeutic dose (15 ml/kg) of autologous FFP might reduce blood loss during elective coronary artery bypass surgery. Sixty patients scheduled for cardiopulmonary bypass were randomized to receive an intravenous infusion of either 15 ml/kg autologous FFP (obtained by plasmapheresis before surgery) or 6% hydroxyethyl starch, 450/0.7.
The same standard anesthetic and porcine heparin were administered to patients at an initial dose of 3,000 IU/kg for anticoagulation. After rewarming, discontinuation of cardiopulmonary bypass, and adequate heparin neutralization (indicated by a return of postprotamine activated clotting time values to within 10% of the preheparin value), an infusion of either FFP or hetastarch was administered to patients. Although the investigators were not blinded as to which substance was being administered, they followed a detailed transfusion protocol. Chest tube drainage volumes were recorded up to 24 h after surgery, and samples of the fluid were collected 6 h postoperatively for measurement of hematocrit.
Four patients were excluded from final analysis. In the remaining 56 patients, chest tube drainage during the first 24 h after surgery ranged from 450 to 1,840 ml (median, 630 ml) in the FFP group and from 340 to 1,980 ml (median, 830 ml) in the hydroxyethyl starch group. Hematocrit of the drainage fluid was similar in both groups, and total perioperative erythrocyte transfusion requirements did not differ significantly between the groups. Prophylactic administration of a therapeutic dose of FFP failed to reduce blood loss and transfusion requirements in these patients undergoing uncomplicated, elective, primary coronary artery bypass surgery.