Fresh Frozen Plasma Transfusion Practices and Coagulation Response in Real-World Clinical Settings: Focus on Indications and Dosing

Background: Fresh frozen plasma (FFP) is widely used to correct coagulopathy.However, many transfusions are administered without adherence to guidelines.The clinical utility of pre-transfusion coagulation tests and optimal dosing strategies remains poorly defined in practice.Methods: We retrospectively reviewed 181 adult patients who received FFP transfusions at a tertiary hospital from January to December 2023.Indications were selected by clinicians from a predefined checklist.Changes in prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT), and fibrinogen were analyzed.Multivariate linear regression was used to predict PT-INR correction.Time to post-transfusion testing was also evaluated.Results: Among 518 episodes, 39.6% of transfusions were administered to patients with a PT-INR1.7,indicating that the guideline criteria were not met.The median volume was 7.0 mL/kg, with only 16.2% exceeding 10 mL/kg.Pre-transfusion PT-INR was the strongest predictor of correction (=-1.003,P0.001).Greater volumes of transfused FFP led to better correction, especially in individuals with PT-INR 3.0.The median time to follow-up testing was 8.5 hours, but showed no significant effect on correction.Conclusion: FFP transfusion was most effective in patients with severe PT-INR prolongation.Frequent inappropriate transfusions and subtherapeutic dosing limited its effectiveness.These findings highlight the importance of targeted education and implementation of INR-based indications to improve FFP transfusion practices.(