Question 8 (prognostic)
In patients with critical bleeding requiring massive transfusion, at what INR (or PT/APTT) for FFP, fibrinogen level for cryoprecipitate and platelet count for platelets concentrates should patients be transfused to avoid risks of significant adverse events?
APTT, activated partial thromboplastin time; FFP, fresh frozen plasma; INR, international normalised ratio; PT, prothrombin time
The systematic review found no studies relevant to the identification of an INR (or prothrombin time [PT]/activated partial thromboplastin time [APTT]), fibrinogen level, or platelet count to trigger a blood component transfusion in patients with critical bleeding requiring massive transfusion.
There are no published data on the trigger levels for blood components. Therefore, the CRG developed practice points that integrate information from other sources, including previously published guidelines and consensus recommendations.
Most important in the management of these patients is regular assessment of the efficacy of replacement therapy using clinical assessment of microvascular bleeding and ongoing monitoring of coagulation parameters. Because there is an unavoidable delay in provision of laboratory results, the use of point-of-care testing, including thromboelastography, is increasing. The review did not include point-of-care testing.
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Practice points
| PP10 | In patients with critical bleeding requiring massive transfusion, suggested doses of blood components are:a
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| APTT, activated partial thromboplastin time; FFP, fresh frozen plasma; INR, international normalised ratio; MTP, massive transfusion protocol; PP, practice point; PT, prothrombin time | |