Fresh frozen plasma and transfusional contribution in cardiac surgery

During a cardiac act of surgery with cardiopulmonary bypass (CPB), the Consecutive surgical lesions with the act of dissection and the contact of blood with thrombogenic Surfaces involve an activation of the hemostasis and raise the hemorrhagic risk. The indications of the transfusion of fresh frozen plasma (FFP) in cardiac surgery are not consensual and very make to the object of argumentations "medico-surgical team dependant" related to complexity on the situation. In France, the decree of the 12/3/1991 stipulates that "the use with the fine therapeutic ones of FFP is strictly reserved for the situations which it requires in an indisputable way". If the major indication of FFP is limited to the treatment and the assumption of responsibility of the hemorrhages of medical causes, it proves that, in certain situations in cardiac surgery, the FFP are also used like products of filling. This complexity of approach of the transfusional practices explains the great disparity of regulations from one center to another like showed it the Plasmacard Study. In this Study, among the patients presenting, a serious bleeding, 60% of them received a transfusion of FFP with,I median volume varying from 7.14 ml/kg with 20.87 ml/kg according to the centers. No clinical Study showed that the prophylactic administration of FFP improves the hemostasis with the waning of a CPB. Nevertheless, the prescription of FFP associated or not with other hemostatic blood products, is recommended for any microvascular bleeding. These prescriptions aim to compensate a hemostatic failure which it is difficult to evaluate and to envisage by standardized procedures. (C) 2009 Elsevier Masson SAS. All rights reserved.