Warfarin reversal emerging as the major indication for fresh frozen plasma use at a tertiary care hospital

Abstract

Because of the increase in the use of warfarin in the population in recent years, reversal of warfarin-related coagulopathy has become common in daily hospital practice. Transfusion of fresh frozen plasma (FFP) is the preferred treatment method for urgent warfarin reversal in the USA. We have undertaken a 1-month audit of FFP usage to ascertain the impact of warfarin use on the consumption of FFP. Sixty percent of the 376 units of FFP that were transfused during the study month were used to reverse warfarin effects. The most common reason to reverse warfarin was bleeding. Thirty-three percent of the units were used for the treatment of other coagulopathies, 7% were used in therapeutic plasmapheresis, and <1% was transfused empirically. One hundred and eighteen patients received FFP during the study month. The study population consisted mostly of elderly patients (65%); however, the warfarin reversing patients consisted disproportionately more of elderly patients (75%) compared with patients receiving FFP for other reasons (46%) (P = 0.0032). Warfarin reversal emerged as the major indication for FFP use in this study. Blood banks of hospitals serving a predominantly elderly patient population should anticipate a higher consumption of FFP. Careful monitoring of warfarin therapy, stringent implementation of the warfarin reversal guidelines, and the introduction of newer products for warfarin reversal would help reduce the consumption of FFP.