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

Summary

In 12,889 cardiac surgery patients receiving platelets for perioperative bleeding, adjunctive fresh frozen plasma (vs cryoprecipitate) was associated with higher operative and 1-year mortality, acute kidney injury, infection, and longer ICU stay after entropy balancing. Results suggest potential benefit of cryoprecipitate as adjunctive therapy.

Key Findings

• Multi-institutional cohort from 58 centers (2005–2021) included 12,889 platelet-transfused cardiac surgery patients.
• Compared with cryoprecipitate, adjunctive FFP was associated with higher operative mortality (RR 1.49) and 1-year mortality (RR 1.37) after entropy balancing.
• FFP use was also associated with increased acute kidney injury (RR 1.16), all-cause infection (RR 1.14), and longer ICU stay (mean +8.02 days).

Clinical Implications

When platelets are indicated for perioperative bleeding in cardiac surgery, consider cryoprecipitate as the adjunctive product of choice while awaiting prospective validation; embed product selection into goal-directed hemostasis algorithms.

Limitations

• Observational design with potential residual confounding and indication bias despite advanced weighting.
• Granular laboratory hemostasis metrics and product dosing details may be limited in registry data.

Future Directions

Prospective comparative effectiveness studies or pragmatic RCTs to validate product selection; integrate viscoelastic-guided algorithms to tailor adjunct choice.