The use of fresh frozen plasma after major hepatic resection for colorectal metastasis: Is there a standard for transfusion? Journal Article
| Authors: | Martin, R. C. G.; Jarnagin, W. R.; Fong, Y.; Biernacki, P.; Blumgart, L. H.; DeMatteo, R. P. |
| Article Title: | The use of fresh frozen plasma after major hepatic resection for colorectal metastasis: Is there a standard for transfusion? |
| Abstract: | BACKGROUND: Major hepatic resection is indicated for selected patients with colorectal metastasis to the liver. Transfusion of fresh frozen plasma (FFP) might be required after major hepatectomy because of blood loss or coagulopathy, but there are no standard criteria for the use of FFP in this setting. METHODS: We identified 260 patients from our prospective database who underwent major (≥3 Couinaud segments) hepatectomy between May 1997 and February 2001 for colorectal metastasis. FFP use was determined and tested for its relationship to clinical and pathologic factors. A survey on FFP use was sent to 12 other hepatobiliary centers worldwide. RESULTS: There were 142 (55%) men, 118 (45%) women, and the median age was 63 years. The most common hepatic resections performed were right lobectomy (37%) and extended right lobectomy (33%). There were 83 (32%) patients who received FFP. In these patients, a total of 405 units of FFP were administered with a median of 4 units. The majority of patients who received FFP were transfused within the first two postoperative days, while there were only five (2%) patients who initially received FFP beyond that time. FFP was administered for a median prothrombin time of 16.9. Only one (0.4%) patient required reoperation for bleeding. Right lobectomy and extended right lobectomy were found to predict FFP use on multivariate analysis. Postoperative complications did not correlate with FFP use. The criteria used for FFP administration at other major hepatobiliary centers were found to be variable. CONCLUSIONS: There is no universal standard for FFP use following major hepatic resection for colorectal metastasis. Our criterion of a prothrombin time of 16-18 seconds is conservative but results only rarely in reoperation for bleeding. Prospective evaluation of a higher threshold for FFP administration, such as an International Normal Ratio of 2.0, should be performed to better define the guidelines for FFP use in patients undergoing major hepatectomy who have normal underlying hepatic parenchyma. © 2003 by the American College of Surgeons. |
| Keywords: | adolescent; adult; treatment outcome; aged; middle aged; cancer surgery; major clinical study; clinical trial; liver neoplasms; postoperative care; prospective studies; bleeding; heart disease; lung disease; abdominal abscess; health survey; colorectal carcinoma; pneumonia; postoperative complication; colorectal neoplasms; prothrombin time; liver metastasis; correlation analysis; liver resection; hepatectomy; blood clotting disorder; databases, factual; wound infection; plasma; liver lobectomy; fresh frozen plasma; plasma transfusion; blood component transfusion; humans; human; male; female; priority journal; article |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 196 |
| Issue: | 3 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2003-03-01 |
| Start Page: | 402 |
| End Page: | 409 |
| Language: | English |
| DOI: | 10.1016/s1072-7515(02)01752-0 |
| PUBMED: | 12648692 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 12 September 2014 -- Source: Scopus |
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