Dose‐associated pulmonary complication rates after fresh frozen plasma administration for warfarin reversal. (2nd February 2016)

• Record Type: Journal Article
• Authors: Marshall, A. L.; Levine, M.; Howell, M. L.; Chang, Y.; Riklin, E.; Parry, B. A.; Callahan, R. T.; Okechukwu, I.; Ayres, A. M.; Nahed, B. V.; Goldstein, J. N.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 14:Number 2(2016:Feb.)
• Page Start: 324
• Page End: 330
• Publication Date: 2016-02-02
• Subjects: blood component transfusion -- fresh frozen plasma -- pulmonary edema -- warfarin; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.13212
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract : Essentials Fresh frozen plasma (FFP) may be associated with a dose‐based risk of pulmonary complications. Patients received FFP for warfarin reversal at a large academic hospital over a 3‐year period. Almost 20% developed pulmonary complications, and the risk was highest after > 3 units of FFP. The risk of pulmonary complications remained significant in multivariable analysis. Summary: Background: Fresh frozen plasma (FFP) is often administered to reverse warfarin anticoagulation. Administration has been associated with pulmonary complications, but it is unclear whether this risk is dose‐related. Aims: We sought to characterize the incidence and dose relationship of pulmonary complications, including transfusion‐associated circulatory overload (TACO) and transfusion‐related acute lung injury (TRALI), after FFP administration for warfarin reversal. Methods: We performed a structured retrospective review of patients who received FFP for warfarin reversal in the emergency department (ED) of an academic tertiary‐care hospital over a 3‐year period. Logistic regression was used to explore the relationship between FFP dose and risk of pulmonary events. Results: Two hundred and fifty‐one patients met the inclusion criteria. Overall, 49 patients (20%) developed pulmonary complications, including 30 (12%) with TACO, two (1%) with TRALI, and 17 (7%) with pulmonary edema not meeting the criteria for TACO. Pulmonary complications were significantly more frequent in those who received > 3 units of FFP (34.0% versus 15.6%, 95% confidence interval for risk difference 7.9%–8.9%). After stratification by subtype of complication, only the risk of TACO was statistically significant (28.3% versus 7.6%, 95% confidence interval for risk difference 8.2%–16.6%). In multivariable analysis controlling for age, sex, initial systolic blood pressure, and intravenous fluids given in the ED, > 3 units of FFP remained a significant risk factor for pulmonary complications (odds ratio 2.49, 95% confidence interval 1.21–5.13). Conclusions: Almost 20% of patients who received FFP for warfarin reversal developed pulmonary complications, primarily TACO, and this risk increased with > 3 units of FFP. Clinicians should be aware of and prepared to manage these complications.