Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice.
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.


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).


CONCLUSIONS
This study suggests that proactive administration of PLTs and FFP improves coagulation competence, reduces postoperative hemorrhage, and increases survival in massively bleeding rAAA patients.
Johansson
Pär I
PI
Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. p.johansson@post.tele.dk
Stensballe
Jakob
J
Rosenberg
Iben
I
Hilsløv
Tanja L
TL
Jørgensen
Lisbeth
L
Secher
Niels H
NH
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D001792:Blood Platelets; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010949:Plasma; D010976:Platelet Count; D017713:Platelet Transfusion / Q000379:methods*; D011182:Postoperative Care; D011517:Prothrombin Time; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome