Is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion?
Background Blood transfusions have become a vital intervention in trauma care. There are limited data on the safety and effectiveness of submassive transfusion (SMT), that is defined as receiving less than 10 units packed red blood cells (PRBCs) in the first 24 hours. This study aimed to evaluate th...
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BMJ Publishing Group
2024-09-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001310.full |
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| author | Faisal Jehan Kartik Prabhakaran Jorge Con Joshua Klein Bardiya Zangbar Aryan Rafieezadeh Ilya Shnaydman |
| author_facet | Faisal Jehan Kartik Prabhakaran Jorge Con Joshua Klein Bardiya Zangbar Aryan Rafieezadeh Ilya Shnaydman |
| author_sort | Faisal Jehan |
| collection | DOAJ |
| description | Background Blood transfusions have become a vital intervention in trauma care. There are limited data on the safety and effectiveness of submassive transfusion (SMT), that is defined as receiving less than 10 units packed red blood cells (PRBCs) in the first 24 hours. This study aimed to evaluate the efficacy and safety of fresh frozen plasma (FFP) and platelet transfusions in patients undergoing SMT.Methods This is a retrospective cohort, reviewing the Trauma Quality Improvement Program database spanning 3 years (2016 to 2018). Adult patients aged 18 years and older who had received at least 1 unit of PRBC within 24 hours were included in the study. We used a multivariate regression model to analyze the cut-off units of combined resuscitation (CR) (which included PRBCs along with at least one unit of FFP and/or platelets) that leads to survival improvement. Patients were then stratified into two groups: those who received PRBC alone and those who received CR. Propensity score matching was performed in a 1:1 ratio.Results The study included 85 234 patients. Based on the multivariate regression model, transfusion of more than 3 units of PRBC with at least 1 unit of FFP and/or platelets demonstrated improved mortality compared with PRBC alone. Among 66 319 patients requiring SMT and >3 units of PRBCs, 25 978 received PRBC alone, and 40 341 received CR. After propensity matching, 4215 patients were included in each group. Patients administered CR had a lower rate of complications (15% vs 26%), acute respiratory distress syndrome (3% vs 5%) and acute kidney injury (8% vs 11%). Rates of sepsis and venous thromboembolism were similar between the two groups. Multivariate regression analysis indicated that patients receiving 4 to 7 units of PRBC alone had significantly higher ORs for mortality than those receiving CR.Conclusion Trauma patients requiring more than 3 units of PRBCs who received CR with FFP and platelets experienced improved survival and reduced complications.Level of evidence Level III retrospective study. |
| format | Article |
| id | doaj-art-e7b913e4bbbc4c2a81797a6d692f0bdc |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-e7b913e4bbbc4c2a81797a6d692f0bdc2025-01-01T14:05:13ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-09-019110.1136/tsaco-2023-001310Is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion?Faisal Jehan0Kartik Prabhakaran1Jorge Con2Joshua Klein3Bardiya Zangbar4Aryan Rafieezadeh5Ilya Shnaydman6Surgery, Westchester Medical Center, Valhalla, New York, USASurgery, Westchester Medical Center Health Network, Valhalla, New York, USASurgery, Westchester Medical Center, Valhalla, New York, USASurgery, Westchester Medical Center, Valhalla, New York, USASurgery, Westchester Medical Center, Valhalla, New York, USASurgery, Westchester Medical Center, Valhalla, New York, USASurgery, Westchester Medical Center, Valhalla, New York, USABackground Blood transfusions have become a vital intervention in trauma care. There are limited data on the safety and effectiveness of submassive transfusion (SMT), that is defined as receiving less than 10 units packed red blood cells (PRBCs) in the first 24 hours. This study aimed to evaluate the efficacy and safety of fresh frozen plasma (FFP) and platelet transfusions in patients undergoing SMT.Methods This is a retrospective cohort, reviewing the Trauma Quality Improvement Program database spanning 3 years (2016 to 2018). Adult patients aged 18 years and older who had received at least 1 unit of PRBC within 24 hours were included in the study. We used a multivariate regression model to analyze the cut-off units of combined resuscitation (CR) (which included PRBCs along with at least one unit of FFP and/or platelets) that leads to survival improvement. Patients were then stratified into two groups: those who received PRBC alone and those who received CR. Propensity score matching was performed in a 1:1 ratio.Results The study included 85 234 patients. Based on the multivariate regression model, transfusion of more than 3 units of PRBC with at least 1 unit of FFP and/or platelets demonstrated improved mortality compared with PRBC alone. Among 66 319 patients requiring SMT and >3 units of PRBCs, 25 978 received PRBC alone, and 40 341 received CR. After propensity matching, 4215 patients were included in each group. Patients administered CR had a lower rate of complications (15% vs 26%), acute respiratory distress syndrome (3% vs 5%) and acute kidney injury (8% vs 11%). Rates of sepsis and venous thromboembolism were similar between the two groups. Multivariate regression analysis indicated that patients receiving 4 to 7 units of PRBC alone had significantly higher ORs for mortality than those receiving CR.Conclusion Trauma patients requiring more than 3 units of PRBCs who received CR with FFP and platelets experienced improved survival and reduced complications.Level of evidence Level III retrospective study.https://tsaco.bmj.com/content/9/1/e001310.full |
| spellingShingle | Faisal Jehan Kartik Prabhakaran Jorge Con Joshua Klein Bardiya Zangbar Aryan Rafieezadeh Ilya Shnaydman Is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion? Trauma Surgery & Acute Care Open |
| title | Is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion? |
| title_full | Is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion? |
| title_fullStr | Is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion? |
| title_full_unstemmed | Is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion? |
| title_short | Is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion? |
| title_sort | is there a need for fresh frozen plasma and platelet transfusion in trauma patients receiving submassive transfusion |
| url | https://tsaco.bmj.com/content/9/1/e001310.full |
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