EFFECT OF FRESH FROZEN PLASMA (FFP) TRANSFUSION ON PROTHROMBIN TIME (PT) AND BLEEDING CONTROL IN PATIENTS WITH CHRONIC LIVER DISEASE

초록

Backgrounds: In chronic liver disease, prothrombin time (PT) orPT-INR has been used for markers of abnormal liver function and bleeding tendency. Fresh frozen plasma (FFP) is one of the blood products frequently used for correcting coagulation abnormalities in patients with chronic liver disease. Our studies were aimed to evaluate the effect of FFP transfusion on correction of PT abnormalities (PT or PT-INR) and bleeding tendency inpatients with chronic liver disease. Methods: We analyzed thed ata of 200 patients transfused with FFP between January 2008 and December 2009 retrospectively (chronic liver disease, CLD, n=140; control, NC, n=60). Among them, 167 patients got FFP transfusion for prophylaxis of bleeding and 33 patients received FFP for management of active bleeding. Data were compared pre- and post-FFP transfusion using PT-sec, -%,-INR. Bleeding was graded according to WHO classification(0: no bleeding, 1: petechial bleeding, 2: mild blood loss, 3: gross blood loss requiring transfusion, 4: debilitating blood loss retinal or cerebral, associated with mortality). Results: The amount of FFP transfusion in CLD and NC were 1800 and 2293 ml, respectively (p=ns). In chronic liver disease patients, the PT levels of pre-transfusion (PT-sec, PT-%, PT-INR) were 21.4 sec, 50.3 %,, 1.88 which were not significantly different from the levels of post-transfusion, 20.9 sec, 51.4 %, and 1.82 in all three scales (p-value>0.05). In control group with hematologic abnormalities, PT levels changed from 16.7 sec, 67.3 %, and 1.41 to 15.6 sec, 72.5 %, and 1.32, all of which also were not significantly different (p-value>0.05). Among the 167 patients who got prophylactic FFP transfusion, 10 patients developed bleeding which was WHO grade 3 or 4 and all of them were CLD. The change of PT levels between pre- and post- transfusion, were not significantly different in chronic liver disease with or without bleeding (PT-sec, -0.3 vs -0.6, PT-%, 2.2 vs 0.7, PT-INR -0.01 vs -0.08, p=NS). Conclusions: FFP is frequently prescribed in patients with chronic liver disease who have abnormal PT levels, but FFP transfusion had minimal effect on improvement of PT and did not affect significantly on bleeding event in chronic liver disease patients. On the basis of our study, PT-INR seems to have a limitation as an indicator for bleeding tendency, need of transfusion or as a tool to assess the improvement of anticoagulation after transfusion. Therefore,development of a new indicator which can reflect the true bleeding risks is needed.