UMEM Educational Pearls

Prophylactic FFP for Procedures?

  • FFP is commonly transfused to correct abnormal coagulation studies prior to performing procedures in nonbleeding critically ill patients.
  • Despite common practice, there is little to no supportive evidence to demonstrate a clinical benefit to transfusing FFP in this patient population.
  • Muller, et al recently evaluated the use of FFP before invasive procedures in critically ill patients.  Brief highlights include:
    • Prospective, randomized, open-label study at 4 sites in the Netherlands
    • 76 adult ICU patients with INRs between 1.5 and 3.0
    • Procedures: central line placement, thoracentesis, percutaneous tracheostomy
    • Result: no difference in major bleeding events between those who received FFP and those randomized to no FFP
  • Take Home Point: In the nonbleeding critically ill patient, routine transfusion of FFP to correct lab abnormalities prior to procedures is not indicated.


  1. Hunt B. Bleeding and coagulopathies in critical care. NEJM 2014; 370:847-59.
  2. Muller MC, et al. Transfusion of fresh-frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial. Transfusion 2014; epub ahead of print.