Role of fresh frozen plasma infusion in correction of coagulopathy of chronic liver disease: a dual phase study.

Objective: Fresh frozen plasma infusions are commonly used to correct the prolonged prothrombin time in patients with advanced chronic liver disease. The aim of this study was to establish how frequently this treatment is effective in correcting this coagulopathy.

Methods: A split retrospective-prospective study design was employed. In the retrospective series, 80 patients were identified with prolongation of the prothrombin time who received fresh frozen plasma infusions. In the prospective arm, 20 patients were included. All patients had confirmed chronic liver disease and showed no response to vitamin K injections. None of the patients had evidence of disseminated intravascular coagulation. The indications for infusion of fresh frozen plasma, number of units administered, complications, and percentage of patients who corrected their prothrombin time to less than 3 s longer than control time were recorded.

Results: The majority of patients (75%) received 2-4 units of fresh frozen plasma. The mean prothrombin time was numerically improved by the infusion of 2-6 units of fresh frozen plasma. However, using correction to less than 3 s longer than control time as an endpoint, only 12.5% of the retrospective and 10% of the prospective study groups respectively had correction of their coagulopathy. Only one complication of infusion of plasma was noted during the course of the study.

Conclusions: Our results reiterate previous observations made more than 45 yr ago, that fresh frozen plasma infusions using the number of units commonly employed in clinical practice infrequently correct the coagulopathy of patients with chronic liver disease. Higher volumes (6 or more units) may be more effective but are rarely employed.