title: Fresh-frozen plasma transfusion did not reduce 30-day mortality in patients undergoing cardiopulmonary bypass cardiac surgery with excessive bleeding: the PLASMACARD multicenter cohort study.
abstract: BACKGROUND
  During on-pump cardiac surgery, hemorrhagic complications occur frequently. Fresh-frozen plasma (FFP) is widely transfused to provide coagulation factors. Yet, no randomized clinical trial has demonstrated its benefits on mortality. We assessed the relationship between therapeutic transfusion of FFP and 30-day mortality in cardiac surgery patients suffering from excessive bleeding in a prospective cohort study.
  
  
  METHODS
  Adult patients who underwent on-pump cardiac surgery and experienced excessive bleeding during the 48-hour perioperative period were recruited from 15 French centers between February 2004 and January 2006. Patients who received a preventive FFP transfusion were excluded. The association between FFP transfusion and all cause 30-day mortality was estimated using a Cox proportional hazards model, adjusted for confounding. A propensity score (PS) sensitivity analysis was also performed.
  
  
  RESULTS
  Among 967 patients included in this study, 58.1% received FFP. The median dose was 11.3 mL/kg (interquartile range, 7.6-19.5). The cumulative 30-day mortality rate was 11.3% (95% confidence interval [CI], 9.5-13.5). FFP transfusion was associated with a higher 30-day mortality (hazard ratio [HR], 3.2; 95% CI, 1.7-6.1) in univariate analysis; however, after adjusting for prognostic factors, there was no longer any association (HR, 1.5; 95% CI, 0.8-3.0, p = 0.20). The results of the PS analysis were consistent with the adjusted analysis.
  
  
  CONCLUSIONS
  Among on-pump cardiac surgery patients experiencing excessive perioperative bleeding, there is no evidence of a beneficial impact of FFP transfusion on mortality.
authors.affiliation: Pole de Sante Publique et CIC-EC7, Unité de Soutien Méthodologique à la Recherche Clinique et Épidémiologique, CHU de Bordeaux, Bordeaux, France; CIC-EC7 et Centre INSERM U897-Epidemiologie-Biostatistique, INSERM, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Université Bordeaux, Bordeaux, France.
authors.forename: Adélaïde
authors.initials: A
authors.lastname: Doussau
authors.forename: Paul
authors.initials: P
authors.lastname: Perez
authors.forename: Maryse
authors.initials: M
authors.lastname: Puntous
authors.forename: Joachim
authors.initials: J
authors.lastname: Calderon
authors.forename: Michel
authors.initials: M
authors.lastname: Jeanne
authors.forename: Christine
authors.initials: C
authors.lastname: Germain
authors.forename: Bertrand
authors.initials: B
authors.lastname: Rozec
authors.forename: Virginie
authors.initials: V
authors.lastname: Rondeau
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ouattara
authors.forename: Gérard
authors.initials: G
authors.lastname: Janvier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016913:Blood Component Transfusion / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality*; D002315:Cardiopulmonary Bypass / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010949:Plasma; D019106:Postoperative Hemorrhage / Q000401:mortality* / Q000628:therapy