Outcomes of Patients Who Undergo Transfusion of Fresh Frozen Plasma: A Prospective, Observational, Multicentre Cohort Study in Hiroshima, Japan

Abstract

Purpose

Given the chronic shortage of blood for transfusion in Japan, promotion of appropriate use of fresh frozen plasma (FFP) urgently needs to be addressed by the national blood project in Japan. Whether FFP transfusions are administered appropriately in Japan is currently unclear. In this study, we aimed to investigate the outcomes of patients who undergo FFP transfusion and the appropriateness of use of FFP.

Patients and Methods

This multicentre, prospective, observational cohort study was conducted from September 2017 to April 2019 at the 15 medical institutions in Hiroshima Prefecture that are the top providers of FFP. All patients who underwent FFP transfusion during the study period were included, relevant data being extracted from the medical records. The indications for FFP transfusion were classified in accordance with the Guidelines of the Ministry of Health, Labour and Welfare of Japan. Factors associated with patient outcomes at day 28 after FFP transfusion were subjected to multivariable logistic regression analysis.

Results

In total, data of 1299 patients were eligible for analysis. At least 63.8% of indications for FFP were in accordance with the guideline for FFP transfusions. The mortality rate at day 28 after FFP transfusion was 16.2%. Older age (65–74 years: adjusted odds ratio [AOR]=4.3, ≥75 years: AOR=4.1), non-perioperative use (AOR=4.5), coagulopathy associated with liver damage (AOR=2.7), large volume of FFP transfused (AOR=2.5), and lack of improvement in blood coagulation following FFP transfusion were independently and significantly associated with death within 28 days after FFP transfusion.

Conclusion

Our findings do not support the simple conclusion that FFP transfusions contribute to prognosis. However, given that coagulopathy in patients with end-stage liver disease is infrequently improved by FFP transfusion, “inappropriate” use of FFP should be avoided. It is important to promote appropriate use of FFP so as not to waste blood resources.

Keywords:

• prognosis
• coagulopathy
• inappropriate use
• compliance with guideline

Acknowledgments

We thank the following institutions in Hiroshima for their contributions to this survey: Hiroshima University Hospital, Hiroshima City Asa Citizens Hospital, Hiroshima Prefectural Hospital, Kure Kyosai Hospital, JA Onomichi General Hospital, JA Hiroshima General Hospital, Hiroshima City Hiroshima Citizens Hospital, Hiroshima-Nishi Medical Center, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Miyoshi Central Hospital, Shobara Red Cross Hospital, Higashi Hiroshima Medical Center, Onomichi Municipal Hospital, National Hospital Organization Fukuyama Medical Center, and Fukuyama City Hospital.

We also thank Dr Trish Reynolds, MBBS, FRACP, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that was in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas. Especially, Aya Sugiyama and Junko Tanaka had a great contribution to analysing the data. Aya Sugiyama and Teruhisa Fujii mainly wrote the manuscripts, and the rest of all authors critically reviewed it. All authors gave final approval of the manuscript version to be published and agreed to be accountable for every aspect of the work.

Disclosure

Dr Masazumi Okajima reports grants from Ministry of Health, Labour and Welfare of Japan, during the conduct of the study; personal fees from Chugai Pharmaceutical Co., Ltd., Taiho Pharma, Johnson and Johnson K. K., Medicaroid Corporation, Eli Lily Japan K. K., Olympus Corporation, and Covidien Japan Inc., outside the submitted work. The authors declare that they have no other conflicts of interest in this work.

Additional information

Funding

This work was supported by a Political Research Grant for Appropriate Use of Blood Product in 2017 and 2018 from the Ministry of Health, Labour and Welfare of Japan.