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Podcast 185.0: Anticoagulation Reversal

Core EM

Comparison between Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) for the Urgent Reversal of Warfarin in Patients with Mechanical Heart Valves in a Tertiary Care Cardiac Center. Iran J Pharm Res. 2015;14(3):877-885. Fariborz Farsad B, Golpira R, Najafi H, et al.

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Anticoagulation Reversal

Core EM

Background Around 6 million people in the U.S. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Background Around 6 million people in the U.S.

FFP 130
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Episode 68: Liver transplant with Meera Gupta

Critical Care Scenarios

FFP is usually not given prophylactically. . * Chronic thrombocytopenia is common and is monitored to determine when DVT prophylaxis can be started. Platelets >20k are targeted. * If INR >2, vitamin K is given empirically. Bleeding is usually considered a little preferable to clotting, in terms of ease of treatment. *

FFP 130
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CRYOSTAT-2: Early Empiric Cryoprecipitate in Major Trauma

REBEL EM

Most major hemorrhage protocols give a balanced transfusion of PRBCs, FFP, and platelets in ratios approaching concentrations found in whole blood. Fibrinogen and fibrin are often depleted during major trauma as a result of consumption, breakdown, and dilution. Fibrinogen products may also be needed to stabilize clots and stem bleeding.

FFP 114
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Episode 21: Trauma resuscitation with Scott Weingart

Critical Care Scenarios

Continue to use a balanced ratio unless you can use TEG to guide FFP and platelets.* FFP is delayed or unavailable; 2. During the most acute period, mostly transfuse to target vitals (MAP >65 or so). As they begin to achieve hemostasis, things slow down, and it start to become possible to follow labs.

FFP 100
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Data Café Insights: Whole Blood and PRBC Usage

ESO

They received fewer PRBCs, fresh frozen plasma (FFP), and platelets across their LOS, while total units and volumes were similar. Patients who received low titer O+ whole blood in transfusions showed significant improvements in shock index (SI), length of stay (LOS), and in mortality rates.

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Thrombotic Thrombocytopenic Purpura (TTP)

Core EM

Joly, 2017; Sawler, 2020) Fresh frozen plasma (FFP) (contains ADMTS-13) may be used to supplement ADAMTS-13 if there is a delay in initiating TPE in the emergency department (i.e. The first TPE session should be completed prior to administration of any biologic therapies. if the patient is being transferred to another hospital).

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