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Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice.
Transfusion. 2007 Apr; 47(4):593-8.T

Abstract

BACKGROUND

Continued hemorrhage remains a major contributor of mortality in massively transfused patients and those who survive have a higher platelet (PLT) count and a shorter prothrombin time and activated partial thromboplastin time (APTT) than nonsurvivors. It was considered that early substitution with PLTs and fresh-frozen plasma (FFP) would prevent development of coagulopathy and thus improve survival.

STUDY DESIGN AND METHODS

Survival of patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA) was compared after implementing a proactive transfusion therapy encompassing two pooled buffy-coat PLT concentrates (PBPCs) immediately when a rupture of the aorta was suspected and again 30 minutes before aortic unclamping together with FFP administered in a 1:1 ratio to the amount of red blood cells (RBCs) with that of a control group receiving transfusion therapy according to existing recommendations.

RESULTS

The intervention group (n = 50) had a higher PLT count at arrival at the intensive care unit compared to the control group (n = 82; 155 x 10(9)/L vs. 69 x 10(9)/L; p < 0.0001), shorter APTT (39 sec vs. 44 sec; p < 0.001), fewer postoperative transfusions (RBCs, 2 vs. 6; FFP, 2 vs. 4; and PBPCs, 0 vs. 1; p < 0.01), and a higher 30-day survival rate (66% vs. 44%; p = 0.02).

CONCLUSION

This study suggests that proactive administration of PLTs and FFP improves coagulation competence, reduces postoperative hemorrhage, and increases survival in massively bleeding rAAA patients.

Authors+Show Affiliations

Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. p.johansson@post.tele.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17381616

Citation

Johansson, Pär I., et al. "Proactive Administration of Platelets and Plasma for Patients With a Ruptured Abdominal Aortic Aneurysm: Evaluating a Change in Transfusion Practice." Transfusion, vol. 47, no. 4, 2007, pp. 593-8.
Johansson PI, Stensballe J, Rosenberg I, et al. Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice. Transfusion. 2007;47(4):593-8.
Johansson, P. I., Stensballe, J., Rosenberg, I., Hilsløv, T. L., Jørgensen, L., & Secher, N. H. (2007). Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice. Transfusion, 47(4), 593-8.
Johansson PI, et al. Proactive Administration of Platelets and Plasma for Patients With a Ruptured Abdominal Aortic Aneurysm: Evaluating a Change in Transfusion Practice. Transfusion. 2007;47(4):593-8. PubMed PMID: 17381616.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice. AU - Johansson,Pär I, AU - Stensballe,Jakob, AU - Rosenberg,Iben, AU - Hilsløv,Tanja L, AU - Jørgensen,Lisbeth, AU - Secher,Niels H, PY - 2007/3/27/pubmed PY - 2007/9/5/medline PY - 2007/3/27/entrez SP - 593 EP - 8 JF - Transfusion JO - Transfusion VL - 47 IS - 4 N2 - BACKGROUND: Continued hemorrhage remains a major contributor of mortality in massively transfused patients and those who survive have a higher platelet (PLT) count and a shorter prothrombin time and activated partial thromboplastin time (APTT) than nonsurvivors. It was considered that early substitution with PLTs and fresh-frozen plasma (FFP) would prevent development of coagulopathy and thus improve survival. STUDY DESIGN AND METHODS: Survival of patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA) was compared after implementing a proactive transfusion therapy encompassing two pooled buffy-coat PLT concentrates (PBPCs) immediately when a rupture of the aorta was suspected and again 30 minutes before aortic unclamping together with FFP administered in a 1:1 ratio to the amount of red blood cells (RBCs) with that of a control group receiving transfusion therapy according to existing recommendations. RESULTS: The intervention group (n = 50) had a higher PLT count at arrival at the intensive care unit compared to the control group (n = 82; 155 x 10(9)/L vs. 69 x 10(9)/L; p < 0.0001), shorter APTT (39 sec vs. 44 sec; p < 0.001), fewer postoperative transfusions (RBCs, 2 vs. 6; FFP, 2 vs. 4; and PBPCs, 0 vs. 1; p < 0.01), and a higher 30-day survival rate (66% vs. 44%; p = 0.02). CONCLUSION: This study suggests that proactive administration of PLTs and FFP improves coagulation competence, reduces postoperative hemorrhage, and increases survival in massively bleeding rAAA patients. SN - 0041-1132 UR - https://www.unboundmedicine.com/medline/citation/17381616/Proactive_administration_of_platelets_and_plasma_for_patients_with_a_ruptured_abdominal_aortic_aneurysm:_evaluating_a_change_in_transfusion_practice_ L2 - https://doi.org/10.1111/j.1537-2995.2007.01160.x DB - PRIME DP - Unbound Medicine ER -