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Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice

Authors

  • Pär I. Johansson,

    1. From the Departments of Clinical Immunology, Anesthesiology, and Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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  • Jakob Stensballe,

    1. From the Departments of Clinical Immunology, Anesthesiology, and Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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  • Iben Rosenberg,

    1. From the Departments of Clinical Immunology, Anesthesiology, and Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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  • Tanja L. Hilsløv,

    1. From the Departments of Clinical Immunology, Anesthesiology, and Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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  • Lisbeth Jørgensen,

    1. From the Departments of Clinical Immunology, Anesthesiology, and Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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  • Niels H. Secher

    1. From the Departments of Clinical Immunology, Anesthesiology, and Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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  • NHS was supported by Aase and Einar Davidsen's Foundation. JS was supported by Coloplast A/S.

Pär I. Johansson, Director of Transfusion Service, Department of Clinical Immunology, Rigshospitalet 2032, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; e-mail: p.johansson@post.tele.dk.

Abstract

BACKGROUND: Continued hemorrhage remains a major contributor of mortality in massively transfused patients and those who survive have a higher platelet (PLT) count and a shorter prothrombin time and activated partial thromboplastin time (APTT) than nonsurvivors. It was considered that early substitution with PLTs and fresh-frozen plasma (FFP) would prevent development of coagulopathy and thus improve survival.

STUDY DESIGN AND METHODS: Survival of patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA) was compared after implementing a proactive transfusion therapy encompassing two pooled buffy-coat PLT concentrates (PBPCs) immediately when a rupture of the aorta was suspected and again 30 minutes before aortic unclamping together with FFP administered in a 1:1 ratio to the amount of red blood cells (RBCs) with that of a control group receiving transfusion therapy according to existing recommendations.

RESULTS: The intervention group (n = 50) had a higher PLT count at arrival at the intensive care unit compared to the control group (n = 82; 155 × 109/L vs. 69 × 109/L; p < 0.0001), shorter APTT (39 sec vs. 44 sec; p < 0.001), fewer postoperative transfusions (RBCs, 2 vs. 6; FFP, 2 vs. 4; and PBPCs, 0 vs. 1; p < 0.01), and a higher 30-day survival rate (66% vs. 44%; p = 0.02).

CONCLUSION: This study suggests that proactive administration of PLTs and FFP improves coagulation competence, reduces postoperative hemorrhage, and increases survival in massively bleeding rAAA patients.

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