Adjunctive Fresh Frozen Plasma Versus Adjunctive Cryoprecipitate in Cardiac Surgery Patients Receiving Platelets for Perioperative Bleeding

Objective(s): This study was designed to assess the relative association between adjunctive fresh frozen plasma (FFP) or adjunctive cryoprecipitate and morbidity and mortality in cardiac surgery patients receiving platelets for perioperative bleeding.

Design: Retrospective cohort study using inverse probability of treatment weighting with entropy balancing.

Setting: Multi-institutional study of 58 centers using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database from January 1, 2005, to December 31, 2021.

Participants: Cardiac surgery patients who received platelets for perioperative bleeding.

Interventions: Adjunctive FFP versus adjunctive cryoprecipitate transfusion in the perioperative period.

Measurements and main results: A total of 12,889 platelet-transfused patients were assessed. Of these, 8,764 received adjunctive FFP and 4,125 received adjunctive cryoprecipitate, with cryoprecipitate increasing over time relative to FFP. After entropy balancing, compared with adjunctive cryoprecipitate, adjunctive FFP transfusion was associated with increased operative mortality (relative risk [RR]: 1.49, 95% confidence interval [CI]: 1.24, 1.79, p < 0.001); 1-year mortality (RR: 1.37, 95% CI: 1.13, 1.66, p = 0.001); increased risk of acute kidney injury (RR: 1.16, 95% CI: 1.02, 1.33, p = 0.024); all-cause infection (RR: 1.14, 95% CI: 1.02, 1.29, p = 0.026), and intensive care length of stay in days (adjusted mean difference: 8.02, 95% CI: 1.72, 14.33, p = 0.013).

Conclusions: In cardiac surgery patients receiving platelets for perioperative bleeding, adjunctive FFP was independently associated with greater morbidity and mortality compared with adjunctive cryoprecipitate. These hypothesis-generating findings warrant further prospective investigation.