Failure of autologous fresh frozen plasma to reduce blood loss and transfusion requirements in coronary artery bypass surgery

Background: Previous studies failed to demonstrate any benefit from prophyl axis with fresh frozen plasma (FFP) after cardiopulmonary bypass (CPB). The results, however, were limited by either retrospective study design or use of FFP in sub-therapeutic doses (2-3 units). The authors evaluated whether a therapeutic dose (15 ml/kg) of FFP reduces blood loss and transfusion re quirements in elective coronary artery bypass surgery. The risks of multipl e allogeneic blood donor exposure were circumvented by using autologous pla sma. Methods: Sixty adult patients scheduled for elective primary coronary arter y bypass grafting were randomized to receive, after CPB, an intravenous inf usion of 15 ml/kg of either autologous FFP (30 patients) or 6% hydroxyethyl starch 450/0.7 (HES; 30 patients). Autologous plasma was obtained by plate let-poor plasmapheresis several weeks before surgery. Perioperative blood t ransfusions were administered per protocol. Postoperative blood loss was de fined as the chest tube drainage during the first 24 h after surgery. Results: The data from 56 patients (FFP group, 27 patients; HES group, 29 p atients) who completed the study according to protocol were analyzed. Media n postoperative blood loss was 630 ml (range, 450-1,840 ml) and 830 ml (ran ge, 340-1,980 ml) in the FFP and HES groups, respectively (P = 0.08), Both postoperative (0-24 h) and total perioperative erythrocyte transfusion requ irements did not differ significantly between the groups (P = 0.32 and 0.14 , respectively). Conclusion: The prophylactic administration of a therapeutic dose (15 ml/kg ) of autologous FFP after CPB faded to reduce blood loss and transfusion re quirements in patients undergoing uncomplicated, elective, primary coronary artery bypass surgery.