S1295 Increased Mortality for Patients With Cirrhosis and Coagulopathy Undergoing Emergent EGD Receiving Pre-Procedure Fresh Frozen Plasma

Introduction: Coagulopathy is common in patients with cirrhosis and American Association for the Study of Liver Diseases guidelines discourage the use of fresh frozen plasma (FFP) before invasive procedures given its risks outweigh the benefits. Tests such as INR poorly predict bleeding risk in patients with advanced liver disease and transfusion of FFP carries risks including volume overload, transfusion reactions, and increased portal hypertension. However, its role specifically in patients with gastrointestinal bleeding undergoing emergent esophagogastroduodenoscopy (EGD) remains more controversial. This study evaluated the effect of pre-procedure treatment with FFP on mortality in patients with cirrhosis and coagulopathy undergoing emergent endoscopy. Methods: Retrospective cohort study of patients with cirrhosis and coagulopathy (INR ≥1.5) seen in a multi-hospital system who underwent an emergent EGD between 2017-2019. Patients who received and did not receive pre-procedural FFP were compared. Primary outcome was 30-day mortality. Secondary outcomes were the rate of procedure-related bleeding, length of stay, intensive care unit (ICU) admission, and 30-day re-admission. Statistical analyses were performed including multivariate regression analyses to adjust for baseline differences between the cohorts. Results: In this cohort, 109 patients (40.5%) received pre-procedure FFP and 160 (59.4%) patients did not. Patients had similar demographics, CCI score, cirrhosis etiology but those who received FFP had slightly higher model for end-stage liver disease and pre-procedure INR. Thirty-day mortality was significantly higher in the FFP group (33.0% vs 10.0%, P < 0.00001) which remained significant after multivariate analysis adjusting for confounding variables. Additionally, FFP administration was associated with longer hospital stays (8.8 vs 5.8 days, P = 0.0002) and increased ICU admissions (92.7% vs 67.5%, P < 0.00001). There was no significant reduction in procedure-related bleeding (4.6% vs 1.3%, P = 0.12) or 30-day readmission rates (22.0% vs 24.4%, P = 0.77). Patients receiving FFP had higher rates of liver-related deaths (77.8% vs 43.6%, P = 0.025). Conclusion: Pre-procedural FFP administration in patients with cirrhosis undergoing emergent EGD was associated with higher mortality, increased length of stay, and higher ICU admission rates, without reducing any bleeding complications. These findings highlight the lack of benefit and potential risks of FFP even in the setting of gastrointestinal bleeding.