scholarly journals Quantification and Characterisation of Nano-Sized Particles in Cryoprecipitate Units

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4278-4278
Author(s):  
Ji Hui Hwang ◽  
John-Paul Tung ◽  
Robert L Flower ◽  
Natalie M Pecheniuk
Keyword(s):  
Particle Concentration ◽  
Conflicts Of Interest ◽  
Cell Communication ◽  
Fresh Frozen Plasma ◽  
Average Concentration ◽  
Regenerated Cellulose ◽  
Micro Fluidics ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Particle Parameters

Abstract Background Cryoprecipitate is an important blood product derived from fresh frozen plasma. It is primarily used to replenish fibrinogen levels in patients. Currently, there is a lack of studies characterising nano-sized particles, including extracellular vesicles (EVs) in cryoprecipitate. EVs play a key role in cell-to-cell communication in physiological and pathological conditions, through the transference of their bioactive cargo such as proteins, lipids, or nucleic acids. This study utilised modern techniques such as nanoparticle tracking analysis (NTA) to characterise these EVs. Methods We obtained ten individual cryoprecipitate units and determined their particle concentration and size distribution using optimised NTA parameters on the Nanosight NS300 instrument. To prevent blockage of the Nanosight's micro-fluidics, samples are routinely filtered before sample injection. Therefore, we wanted to investigate if different filter materials could impact NTA measurements for cryoprecipitate. Samples were filtered with either regenerated cellulose (RC) or polytetrafluoroethylene (PTFE), with non-filtered samples as control. A one-way ANOVA with Tukey post hoc test was used to compare the particle parameters (particle concentration, mean, mode). Significance was set at p<0.05. Results The results showed that different cryoprecipitate units varied in their particle concentration and size, with an average concentration of 2.501 x 10 11 ± 1.098 x 10 11 particles per mL and a particle mean of 133.8 ± 7.5 nm and mode of 107.9 ±11.06 nm. In addition, only samples filtered using RC were there no significant changes in the measured particle parameters (particle concentration, p=0.936; mean, p=0.999; mode, p=0.996) compared to the non-filtered samples. A significant difference was observed in the mean of particle size between PTFE and RC filters (112.7 ± 6.033 nm, 42 133.8 ± 7.503 nm, p =<0.0001) and between PTFE and non-filtered (112.7 ± 6.033 nm, 133.7 ± 13.63 nm, p =0.0015). PTFE significantly reduced the particle mean compared to both RC and non-filtered. Conclusions Our findings revealed that NTA could be used as a novel method to measure particles in cryoprecipitate. Furthermore, RC filters are compatible with quantitative NTA analysis compared to PTFE filters. Disclosures No relevant conflicts of interest to declare.

Coagulation Disorder after Treatment of Pegaspargase and L-Asparaginase

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4876-4876
Author(s):  
Linwei Xu ◽  
Xiaolei Wei ◽  
Yongqiang Wei ◽  
Fen Huang ◽  
Xiaoxiao Hao ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Remission Rate ◽  
Fresh Frozen Plasma ◽  
Coagulation Disorder ◽  
Acute Lymphatic Leukemia ◽  
Coagulation Function ◽  
Lymphatic Leukemia ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Continuous Use

Abstract Introduction: Pegaspargase(PEG-ASP) and L-asparaginase(L-ASP) has been widely used in the treatment of acute lymphatic leukemia, changes of coagulation function after treatment are not actually the same. So we performed the present study to analyze coagulation disorder after PEG-ASP and L-ASP treatment of adults with acute lymphatic leukemia. Methods and materials: Totally 153 hospitalized patients with acute lymphatic leukemia treated with L-ASP or PEG-ASP were studied from January, 2010 to January, 2015. Of all 153 patients analyzed, they received L-ASP treatment 158 dose times and PEG-ASP treatment 60 dose times respectively. Results: There is no difference of the distribution of age, sex, white blood cell count at diagnosis and risk factors of the disease. Agranulocytosis combining with intestinal infection, bleeding or thrombosis and the inducing remission rate between the two groups has no significant difference (p=0.11,0.61,0.33). The total infusion of fresh frozen plasma or cryoprecipitate or fibrinogen after treatment shows no significant difference between the two groups (p=0.11,0.75,0.21).Fibrinogen level decreases slower in the treatment of PEG-ASP(9.37 day vs 7.40 day, p=0.02) than that of L-ASP. What's more, fibrinogen decreases slower when L-ASP used at interval compared with continuous use, however, the incidence rate of bleeding and related complications is higher when used at interval early (p =0.028). Conslusion: Because of the preponderance to monitor the changes of fibrinogen and the equal rate of complications and inducing remission rate, it is recommended to use PEG-ASP. L-ASP used at interval can monitor the coagulation function easily than continuous use, but the early use of L-ASP may overlay the drug side effects and related hematology toxicity caused by chemotherapy, then cause an increased incidence of complications. Disclosures No relevant conflicts of interest to declare.

Abstract WP304: Prothrombin Complex Concentrate Rapidly Reverses Coagulopathy but does not Alter Mortality in Warfarin Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Xuemei Cai ◽  
Susannah Orzell ◽  
Sarah Suh ◽  
Linda Bresette ◽  
Farzaneh Sorond ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Vitamin K ◽  
Conventional Therapy ◽  
Prothrombin Complex Concentrate ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Thromboembolic Complication ◽  
Complication Rates ◽  
Significant Difference ◽  
Fresh Frozen

INTRODUCTION: Warfarin-associated intracerebral hemorrhage (wICH) remains the most lethal form of iatrogenic stroke. Conventional therapy with fresh frozen plasma (FFP) and intravenous vitamin K takes up to 30 hrs to normalize the international normalized ratio (INR). Prothrombin complex concentrate (PCC) does not require cross-match and is fast acting. We hypothesized that PCC can rapidly reverse coagulopathy and reduce mortality in wICH. Methods: We identified 130 consecutive adult wICH patients over five years from a prospectively collected database. 33 patients were excluded for death or withdrawal of care within 48 hours of admission and 8 patients were excluded for antecedent head trauma, leaving 89 patients for analysis. Forty patients received FFP and vitamin K (conventional therapy) and 49 received PCC in addition to conventional therapy. We compared 6-month mortality, time to INR normalization, quantity of FFP transfused, and thromboembolic complication rates between the two groups. We used logistic regression to adjust for important confounders. Results: PCC-treated and conventional therapy patients had similar distributions of age, sex, co-morbidities, ICH location, initial blood pressure and INR. PCC-treated patients had a higher incidence of intraventicular hemorrhage (IVH) (67% vs 33%). PCC-treated patients required less FFP (mean 6.8 units vs 3.3 units, p<0.0001) and had faster time to INR normalization (mean 3.8 hrs vs 9.8 hrs, p<0.0001). Incidence of ICH expansion was low in both groups. There was no difference in the incidence of deep venous thrombosis and pulmonary embolism (p=0.236) or troponin elevation (p=0.573). There was no significant difference in 6-month mortality (p=0.437) after adjusting for age, ICH location, ICH volume, and presence of IVH. Conclusions: PCC use in wICH was associated with shorter time to INR normalization and reduced FFP transfusion but was not associated with 6-month mortality in this cohort. There was no difference in thromboembolic complication rates between PCC-treated and FFP and vitamin K treated patients. Prospective trials of PCC are necessary to determine if its use can improve morbidity and mortality in wICH and to identify potential subgroups of wICH patients who may benefit from PCC.

Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Hüsnü Kamil Limandal ◽  
Mehmet Ali Kayğın ◽  
Servet Ergün ◽  
Taha Özkara ◽  
Mevriye Serpil Diler ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Artery Bypass ◽  
Length Of Hospital Stay ◽  
Fresh Frozen Plasma ◽  
Wound Complications ◽  
Significant Difference ◽  
Delayed Sternal Closure ◽  
Fresh Frozen ◽  
Major Adverse Events

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

Preprocedural Coagulation Studies in Pediatric Patients Undergoing Percutaneous Intervention for Appendiceal Abscesses

2015 ◽  
Vol 81 (9) ◽  
pp. 859-864 ◽  
Author(s):  
Sandra M. Farach ◽  
Paul D. Danielson ◽  
Nicole M. Chandler
Keyword(s):  
Bleeding Risk ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Percutaneous Intervention ◽  
Bleeding Complications ◽  
Poor Correlation ◽  
Appendiceal Abscess ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Frozen Plasma

The literature reports poor correlation between coagulation screening and prediction of bleeding risk in children. Our aim is to determine whether there is a role for coagulation studies in children undergoing percutaneous intervention for appendiceal abscesses. A retrospective review of 1805 patients presenting with a diagnosis of appendicitis from September 2008 to September 2013 was performed. Patients presenting with appendiceal abscess who underwent percutaneous intervention were selected for further review (n = 131). A total of 76 patients (58%) had normal coagulation studies, whereas 55 (42%) had elevated values. An international normalized ratio ≥ 1.3 was found in 26 patients. Patients with normal coagulation values had an incidence of bleeding of 1.3 per cent. In the abnormal coagulation group, 8 patients received fresh frozen plasma before intervention, whereas 47 did not. There was one hematoma noted in each group with an incidence of bleeding of 3.6 per cent. The overall incidence of hematoma was 2.3 per cent with no significant difference in bleeding risk between the normal and abnormal coagulation groups. In conclusion, although many patients are found to have elevated coagulation studies, most do not have bleeding complications after intervention. There is poor correlation between coagulation screening and postprocedural outcomes evidenced by the low risk of bleeding.

Cryosupernatant and Solvent Detergent Fresh Frozen Plasma (Octaplas, Octapharma) Usage in Acute Thrombotic Thrombocytopenic Purpura-Review of 50 Episodes.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4139-4139
Author(s):  
Marie Scully ◽  
Michael Flynn ◽  
Jenny Berryman ◽  
Samuel J. Machin
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Fresh Frozen Plasma ◽  
Severe Allergic Reaction ◽  
Central Vein ◽  
Allergic Reactions ◽  
Refractory Disease ◽  
Thrombocytopenic Purpura ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Thrombotic thrombocytopenic purpura (TTP) is an acute, life threatening disorder. The mainstay of treatment is plasma exchange (PEX) as a source of ADAMTS 13. In the UK, 20–25% of all plasma consumed is in patients with TTP. In our protocol (up until 31st December 2005) apheresis was initially with cryosupernatant (National Blood Service, UK) unless patients had a previous severe allergic reaction or refractory disease. Apheresis therefore continued with Solvent-Detergent Fresh Frozen Plasma (S/D FFP) Octaplas, (Octapharma, Vienna Austria) virally inactivated plasma, available throughout Europe. We reviewed 50 acute TTP episodes involving 32 patients. Thirteen episodes used cryosupernatant only and in 15 episodes, treatment started with cryosupernatant and changed to Octaplas. The reasons for changing were refractory disease in 2 episodes and major or recurrent allergic reactions to cryosupernatant in 13 cases. Once Octaplas had been used, it was continued on further admissions. In 22 episodes, Octaplas was used exclusively; in 4 cases as physicians choice and in the remaining due to previous reactions to cryosupernatant. The total volume of cryosupernatant used was 508250mls, 27.6% of all plasma; total volume of Octaplas was 1327600mls, 72.4% of all plasma. Citrate mediated reactions associated with symptomatic hypocalcaemia during apheresis were present in 11% of Octaplas and 20% of cryosupernatant. Acute or delayed urticarial or allergic reactions were noted in 5% of Octaplas and 10% cryosupernatant procedures. A particular complication of apheresis is central line infection. There were 21 line infections and in 43% of cases the infection was associated with a reduction in platelet count < 150 × 109/L. In all 50 episodes, the only documented thrombosis was a superficial non central vein in a patient who had received Octaplas. Prevention of venous thrombosis is by use of thromboembolic stockings, low dose aspirin and low molecular weight heparin in patients when platelet counts >50 × 109/L. In episodes receiving only cryosupernatant or Octaplas, there was no significant difference in the median number of PEX to remission, 7(3–14) and 8.5 (5–30) respectively. Baseline viral screen in all episodes was negative after discharge following an acute TTP episode. In conclusion: cryosupernatant and S/D FFP (Octaplas) appear equally efficacious. However, the risk of allergic/urticarial reactions was twice as common with cryosupernatant, as were citrate reactions. Milder allergic reactions to cryosupernatant are possibly higher, but may have been treated with antihistamines and data not recorded. There was no documented viral transmission with either product.

Hemolytic Intravascular Anemia (HIA) Microangiopathic-Like and Deep Venous Thrombosis (DVT) Due to Ozone Exposure: Case Report

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5278-5278
Author(s):  
Luis Fernando Cortázar-Benítez ◽  
Pablo Vargas Viveros ◽  
Alfredo Aiza Alvarez ◽  
Rafael Hurtado Monroy
Keyword(s):  
Conflicts Of Interest ◽  
Laboratory Data ◽  
Peripheral Blood Smear ◽  
Fresh Frozen Plasma ◽  
Ozone Exposure ◽  
Fresh Frozen ◽  
The Right ◽  
Glucose 6 Phosphate Dehydrogenase ◽  
Frozen Plasma

Abstract Abstract 5278 HIA due to ozone exposure on patients with glucose 6 phosphate dehydrogenase deficiency (G6PDd) is extremely rare. The purpose of this report is to describe in detail a case of HIA and DVT on a woman without G6PDd, with a successful treatment with fresh frozen plasma (FFP) transfusion and Thrombolysis. The patient is a 36 years old woman, that 3 months before she was diagnosed with multiple sclerosis (MS) because paresthesias in the fingers of her left foot and she received treatment with blood ozone exposure (at unknown dose) in 3 sessions each week for 3 months. The patient attended to our center with severe anemic syndrome during the last 2 weeks and disabling pain of her left leg of 12 hours of evolution. Physical examination showed pale ++++, jaundice ++, functional systolic murmur grade IV, without adenomegaly or splenomegaly, increasing volume, induration, erythema and intense pain from the ankle to the popliteal space of her left leg. The urine was dark. Laboratory data were haemoglobin 5 g/dL, hematocrit 17%, reticulocytes 62%, and platelets 281×109/L. Peripheral blood smear showed esquistocytes +++ and spherocytes ++, suggesting intravascular hemolysis. Total bilirrubin 2.99mg/dL, direct bilirubin 0.57, and LDH 750 U/L. Doppler ultrasound: obstruction of the deep and superficial venous system of tibial, peroneal and left popliteal veins. Four red cells units were transfused and FFP transfusion was started every 6 hours, anticoagulation with enoxaparina sodium (1mg/Kg/day) and thrombolysis with rhTPA 100 mg for 3 hours infusion. The patient successfully improved with increase and maintenance of hemoglobin, decrease of the reticulocytes count and evident clinical improvement of her left leg. She was in-hospital for 8 days at the end of which was achieved ambulation, Doppler showed remission of DVT. The association between exposure to ozone and HIA has not been informed in the absence of G6PD deficiency, and today, little is known of the ideal treatment. Though plasmapheresis is the treatment of choice in a HIA, the presence of DVT and be in a period appropriate for thrombolysis, determined the use of FFP transfusion as the main treatment. The right clinical evolution observed in the treatment of our patient gave her solving clinical problems. Ozone has been widely used for a variety of off-label purposes. In vitro experiments had demonstrated hemolysis with ozone concentration > 30 mcg/mL, therefore this case must represent an important alert for those ozone users, however the mechanism of hemolysis because ozone exposure remains to be elucidated. Disclosures: No relevant conflicts of interest to declare.

Fresh Frozen Plasma (FFP) Usage and Appropriateness in Adult Medical in-Patients: A Retrospective Audit

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4375-4375
Author(s):  
Raghava Reddy Levaka Veera ◽  
Doron Schneider ◽  
Peter V. Pickens
Keyword(s):  
Vitamin K ◽  
Conflicts Of Interest ◽  
Fresh Frozen Plasma ◽  
Bleeding Complications ◽  
Medical Patients ◽  
Nursing Time ◽  
Inappropriate Use ◽  
Retrospective Audit ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Abstract 4375 BACKGROUND: The use of Fresh Frozen Plasma (FFP) has increased considerably in recent years. In the USA there was 70% increase in the use of plasma in 10 years between 1991 and 2001. Around 3.9 million units were transfused in 2001 and 5.7 million units in 2009. FFP is often used inappropriately globally and studies evaluating FFP use in the US are scarce. We conducted a study to assess the trends of FFP use, its implications, appropriateness, and impact of FFP on International Normalized Ratio (INR) in hospitalized adult medical patients with an elevated INR. DESIGN AND METHODS: The study was a retrospective audit of all adult medical in-patients with an INR of 1.2 or higher who received FFP during a 3 month period from December 1, 2011 to February 28, 2012 admitted to Abington Memorial Hospital. A list of all patients who received FFP during the study period was obtained from the blood bank. Patients with major trauma, surgical, post-op, pediatric and obstetric/gynecological patients were excluded. Data was collected on demographics, indications of FFP, pre and post transfusion INR and effect of FFP on pre-transfusion INR. Partial thromboplastin time values (PTT) were not collected. RESULTS: A total of 479 units of FFP were transfused to 97 patients over 114 transfusion episodes. Of the 97 patients, 51 were male (52.6%) and 46 were female (47.3%) with a mean age of 70.4 yrs (median 73 yrs, range 19–95 yrs). Of the total 479 units of FFP, 233 units (48.6%) were given to patients who were not actively bleeding (n=53) with a mean pre-transfusion INR (pre-INR) of 2.82 (range 1.5 to >10, SD 1.6). Warfarin related coagulopathy was noted in 65 patients (67%) and 340 units of FFP (71%) were transfused to these patients. FFP units transfused as pre-procedural prophylaxis were 176 out of 479 (36.7%). Twenty transfusion episodes amounting to 53 units of FFP (11.1%) were given to patients who were not actively bleeding and had a pre-INR of <2. Six patients did not get the planned procedure done and received 25 units (5.2%) of FFP. Of 15 patients who received FFP as pre-procedure prophylaxis with INR <2, only one (6.6%) had normalized post-transfusion INR (post-INR), 5 (33.3%) had post-INR of <1.5 and none had any bleeding complications. Inappropriate use of FFP in this study was noted to be 23.7% (114/479 units of FFP). Mean improvement in INR per unit of FFP for all transfusion episodes (n=114) was 0.36, with mean pre-INR of 3.28 (range 1.5 to >10) and mean post-INR of 1.72 (range 1.2 to 4.2). Mean improvement in INR/FFP in patients with pre-INR <2 vs. those with pre-INR 2 or higher was 0.22 vs. 0.42 respectively (p=0.021). Mean improvement in INR/FFP was significantly higher in patients with warfarin related coagulopathy vs. in those secondary to other causes (0.46 vs. 0.33, p=0.001). Patients who received vitamin K concurrently with FFP had higher mean improvement in INR/FFP than those who did not receive vitamin K (0.45 vs. 0.17, p=0.001). It was also noted that timing of post-INR check was very heterogeneous. Two patients developed an allergic reaction needing stoppage of transfusion and further treatment. Approximately $6,840 were wasted in direct costs ($60 per unit) in just 3 months for only medical in-patients excluding indirect costs (estimated at $100 per unit= $11,400) such as technician, nursing time; transfusion sets, pre-medication, etc. CONCLUSION: Inappropriate use of FFP remains high even among medical in-patients. This study is consistent with previous studies in finding warfarin reversal as the major indication of FFP use and higher the pre-INR, higher was the improvement in INR. Especially, high percentage of use of FFP for pre-procedural prophylaxis with mild elevation of INR is alarming; therefore, studies evaluating restrictive vs. liberal use of FFP are needed. *ICU=Intensive care unit, PCU= Progressive care unit, ER= Emergency room, GMF= General medical floor. Disclosures: No relevant conflicts of interest to declare.

Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal A systematic review and meta-analysis

2016 ◽  
Vol 116 (11) ◽  
pp. 879-890 ◽  
Author(s):  
Chatree Chai-Adisaksopha ◽  
Christopher Hillis ◽  
Deborah M. Siegal ◽  
Ron Movilla ◽  
Nancy Heddle ◽  
...  
Keyword(s):  
Volume Overload ◽  
Fresh Frozen Plasma ◽  
Red Blood Cell Transfusion ◽  
Cochrane Library ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Fresh Frozen ◽  
Warfarin Reversal ◽  
Frozen Plasma

SummaryUrgent reversal of warfarin is required for patients who experience major bleeding or require urgent surgery. Treatment options include the combination of vitamin K and coagulation factor replacement with either prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). However, the optimal reversal strategy is unclear based on clinically relevant outcomes. We searched in MEDLINE, EMBASE and Cochrane library to December 2015. Thirteen studies (5 randomised studies and 8 observational studies) were included. PCC use was associated with a significant reduction in all-cause mortality compared to FFP (OR= 0.56, 95 % CI; 0.37–0.84, p=0.006). A higher proportion of patients receiving PCC achieved haemostasis compared to those receiving FFP, but this was not statistically significant (OR 2.00, 95 % CI; 0.85–4.68). PCC use was more likely to achieve normalisation of international normalised ratio (INR) (OR 10.80, 95 % CI; 6.12–19.07) and resulted in a shorter time to INR correction (mean difference –6.50 hours, 95 %CI; –9.75 to –3.24). Red blood cell transfusion was not statistically different between the two groups (OR 0.88, 95 % CI: 0.53–1.43). Patients receiving PCC had a lower risk of post-transfusion volume overload compared to FFP (OR 0.27, 95 % CI; 0.13–0.58). There was no statistically significant difference in the risk of thromboembolism following administration of PCC or FFP (OR 0.91, 95 % CI; 0.44–1.89). In conclusion, as compared to FFP, the use of PCC for warfarin reversal was associated with a significant reduction in all-cause mortality, more rapid INR reduction, and less volume overload without an increased risk of thromboembolic events.Supplementary Material to this article is available online at www.thrombosis-online.com.

Investigating the Effect of Fresh Frozen Plasma and Albumin on DNA Damage and Oxidative Stress Biomarkers in Poisoning Cases by Organophosphates

Drug Research ◽  
2020 ◽  
Vol 71 (01) ◽  
pp. 10-16
Author(s):  
Saeed Afzali ◽  
Manoochehr Karami ◽  
Nejat Kheyripour ◽  
Akram Ranjbar
Keyword(s):  
Oxidative Stress ◽  
Dna Damage ◽  
Fresh Frozen Plasma ◽  
Adjunctive Treatment ◽  
Control Group ◽  
Oxidative Stress Biomarkers ◽  
Significant Difference ◽  
Antioxidant Parameters ◽  
Fresh Frozen ◽  
Frozen Plasma

AbstractThe efficacy of albumin and fresh frozen plasma (FFP) and their effects on biomarkers of oxidative stress has been evaluated. In a randomized clinical control trial, 33 poisoned patients by Organophosphate (OP) were enrolled in the research and divided into three groups. The first group underwent conventional treatments by atropine and pralidoxime (control group); the second and third groups, in addition to traditional treatments, received albumin and FFP. Cholinesterase (ChE) enzyme activity, total antioxidant capacity (TAC), serum thiol groups (TTG), malonyl aldehyde (MDA) and DNA damage were measured in all treatment and control groups. Patients were matched in terms of demographic characteristics at the beginning of the study. ChE activity was increased in all three groups during treatment, which was more noticeable in the FFP group and was statistically significant in both albumin and FFP group compared to the control group (p<0.05). TAC increased, and TTG decreased in FFP and albumin groups compared to the control group; no significant difference was observed. MDA decreased in albumin and FFP and was significantly different in the FFP group compared to the control group (p<0.05). The amount of DNA damage in FFP and albumin groups decreased, and there was a significant difference compared to the control group (p<0.05). According to the results of this study, due to the decrease of oxidative damage parameters and the increase of antioxidant parameters in albumin and specially FFP groups, FFP may be considered as an adjunctive treatment for OP poisoning.

scholarly journals An Institutional Survey of Warfarin Reversal in the Setting of Life-Threatening Bleeds

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4981-4981
Author(s):  
Ian Garrahy ◽  
Tushar Pawar ◽  
Anthony Donato ◽  
Amber Stevenson ◽  
Daniel Forman
Keyword(s):  
Conflicts Of Interest ◽  
Factor Viia ◽  
Fresh Frozen Plasma ◽  
P Value ◽  
Anticoagulation Management ◽  
Clinical Scenarios ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Warfarin Reversal ◽  
Frozen Plasma

Introduction: The bleeding risk of warfarin is well known. Therapeutic options for warfarin reversal in life-threatening bleeds include fresh frozen plasma (FFP), recombinant factor VIIa (rFVIIa), and prothrombin complex concentrate (PCC). Despite the theoretical advantage and clinical evidence supporting PCC, it is not widely used in the US. Methods: An online anonymous questionnaire was sent to all providers in the Tower Health System asking them about their practice, specialty, degree, years in practice, and basic questions regarding their comfort and frequency of prescribing anticoagulants. The questionnaire also asked the providers how they would manage ten various clinical scenarios related to anticoagulation management. One question specifically addressed the management of warfarin reversal in an 85-year-old presenting with hemorrhagic shock. Analysis of variance was used to compare the scoring means between groups while linear regression and Pearson's correlation coefficient measured the relationship between years of practice and test scores. Results: Out of 404 responders, 232 (57.4%) selected an incorrect answer and 212 (52.5%) incorrectly selected fresh frozen plasma as the answer to the question (see uploaded image) that addressed warfarin reversal in the setting of major bleeding. Those providers who answered this question correctly and those who answered it incorrectly had mean scores of 68.26% and 52.16% respectively on the overall survey (p value 0.000). Conclusion: As compared to FFP, the use of PCC for warfarin reversal is associated with a significant reduction in all-cause mortality. This project demonstrates a professional practice gap and serves to highlight an area in medicine where many providers are not practicing in accordance with evidence-based practice. Furthermore, this particular question from the survey discovered that providers who performed better on the survey were more likely to answer questions regarding anticoagulation reversal correctly. Figure Disclosures No relevant conflicts of interest to declare.

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