• Matthew A Warner, Arun Chandran, Gregory Jenkins, and Daryl J Kor.
• From the *Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; †Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts; ‡Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; §Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; and ‖Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
• Anesth. Analg. 2017 May 1; 124 (5): 1636-1643.

BackgroundCritically ill patients frequently receive plasma transfusion under the assumptions that abnormal coagulation test results confer increased risk of bleeding and that plasma transfusion will decrease this risk. However, the effect of prophylactic plasma transfusion remains poorly understood. The objective of this study was to determine the relationship between prophylactic plasma transfusion and bleeding complications in critically ill patients.MethodsThis is a retrospective cohort study of adults admitted to the intensive care unit (ICU) at a single academic institution between January 1, 2009 and December 31, 2013. Inclusion criteria included age ≥18 years and an international normalized ratio measured during ICU admission. Multivariable propensity-matched analyses were used to evaluate associations between prophylactic plasma transfusion and outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of hospital- and ICU-free days and mortality within 30 days of ICU discharge.ResultsA total of 27,561 patients were included in the investigation with 2472 (9.0%) receiving plasma therapy and 1105 (44.7%) for which plasma transfusion was prophylactic in nature. In multivariable propensity-matched analyses, patients receiving plasma had higher rates of red blood cell transfusion (odds ratio: 4.3 [95% confidence interval: 3.3-5.7], P < .001) and fewer hospital-free days (estimated % increase: -11.0% [95% confidence interval: -11.4, -10.6%], P < .001). There were no significant differences in ICU-free days or mortality. These findings appeared robust, persisting in multiple predefined sensitivity analyses.ConclusionsProphylactic administration of plasma in the critically ill was not associated with improved clinical outcomes. Further investigation examining the utility of plasma transfusion in this population is warranted.

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