Prophylactic fresh frozen plasma and platelet transfusion have a prothrombotic effect in patients with liver disease

Fien A von Meijenfeldt, Bente P van den Boom, Jelle Adelmeijer, Lara N Roberts, Ton Lisman*, William Bernal

*Corresponding author for this work

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Abstract

Background and Aims Patients with liver disease acquire complex changes in their hemostatic system, resulting in prolongation of the international normalized ratio and thrombocytopenia. Abnormalities in these tests are commonly corrected with fresh frozen plasma (FFP) or platelet transfusions before invasive procedures. Whether these prophylactic transfusions are beneficial and truly indicated is increasingly debated. In this study, we studied ex vivo effects of FFP and platelet transfusions in patients with liver disease-associated hemostatic changes in a real-life clinical setting.

Methods We included 19 patients who were deemed to require prophylactic FFP transfusion by their treating physician and 13 that were prescribed platelet transfusion before a procedure. Hemostatic status was assessed in blood samples taken before and after transfusion and compared with healthy controls (n = 20).

Results Ex vivo thrombin generation was preserved in patients with liver disease before FFP transfusion. Following FFP transfusion, both in and ex vivo thrombin generation significantly increased, as evidenced by a 92% and 38% increase in thrombin-antithrombin and prothrombin fragment 1 + 2 levels, respectively, and a 20% increase in endogenous thrombin potential. Platelet counts increased from 28 [21-41] x 10(9)/L before to 43 [39-64] x 10(9)/L after platelet transfusion (P <.01), and was accompanied by increases in in vivo markers of hemostatic activation.

Conclusions FFP and platelet transfusion resulted in increased thrombin generation and platelet counts in patients with liver disease, indicating a prothrombotic effect. However, whether all transfusions were truly indicated and had a clinically relevant effect is questionable.

Original languageEnglish
Number of pages13
JournalJOURNAL OF THROMBOSIS AND HAEMOSTASIS
Early online date20-Nov-2020
DOIs
Publication statusPublished - 25-Dec-2020

Keywords

  • cirrhosis
  • coagulation
  • fresh frozen plasma
  • neutrophil extracellular traps
  • platelets
  • transfusion
  • ACUTE LUNG INJURY
  • INVASIVE PROCEDURES
  • HEMOSTASIS

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