title: Does resuscitation with plasma increase the risk of venous thromboembolism?
abstract: BACKGROUND
  Resuscitation with blood products improves survival in patients with traumatic hemorrhage. However, the risk of venous thromboembolic (VTE) complications associated with fresh frozen plasma (FFP) resuscitation is unknown. We hypothesized that a higher ratio of FFP to packed red blood cells (PRBCs) given during acute resuscitation increases the risk of VTE independent of severity of injury and shock.
  
  
  METHODS
  The records of patients admitted from April 2007 to December 2011 who had surveillance lower extremity duplex ultrasounds were retrospectively reviewed. Patients who received at least 1 U of PRBCs within 24 hours of admission were included. Patients who died without VTE were excluded. The relationship between FFP and VTE was evaluated using logistic regression.
  
  
  RESULTS
  A total of 381 patients met inclusion criteria, of whom 77 (20.2%) developed VTE. In patients who required less than 4 U of PRBCs, increasing units of FFP were associated with an increasing risk for VTE, with each unit of FFP having an adjusted odds ratio of 1.27 (95% confidence interval, 1.04-1.54, p = 0.015). Conversely, in patients who required four or greater units of PRBCs, FFP in equal or greater ratios than PRBCs was not associated with VTE.
  
  
  CONCLUSIONS
  Each unit of FFP increased VTE risk by 25% in patients who required less than 4 U of PRBCs. In patients who required 4 U or greater PRBCs, FFP administration conferred no increased risk of VTE. This suggests that FFP should be used cautiously when early hemodynamic stability can be achieved with less than 4 U of PRBCs.
  
  
  METHODS
  Care management study, level III.
authors.affiliation: From the Trauma Service, Scripps Mercy Hospital, San Diego, California.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Zander
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Olson
authors.forename: Jan-Michael
authors.initials: JM
authors.lastname: Van Gent
authors.forename: Jesse
authors.initials: J
authors.lastname: Bandle
authors.forename: Richard Y
authors.initials: RY
authors.lastname: Calvo
authors.forename: Steven R
authors.initials: SR
authors.lastname: Shackford
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Peck
authors.forename: C Beth
authors.initials: CB
authors.lastname: Sise
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sise
authors.forename: Bryan S
authors.initials: BS
authors.lastname: King
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D035002:Lower Extremity / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology*