BACKGROUND: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. STUDY DESIGN AND METHODS: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. RESULTS: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. DISCUSSION: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

Department for Internal Medicine University of Ljubljana Ljubljana Slovenia

Department of Anesthesia and Intensive Care Medicine Copenhagen University Hospital Gentofte Hellerup Denmark

Department of Anesthesia and Intensive Care Military Medical Academy Belgrade Belgrade Serbia

Department of Anesthesiology Aga Khan University Hospital Nairobi Kenya

Department of Anesthesiology Amsterdam University Medical Center Amsterdam the Netherlands

Department of Anesthesiology and Intensive Care Institute of Medical Sciences University of Opole Opole Poland

Department of Anesthesiology and Intensive Care IRCCS Humanitas Research Hospital Milan Italy

Department of Anesthesiology and Intensive Care Kepler University Clinic Linz Austria

Department of Anesthesiology and Intensive Care Medicine University Hospital and Faculty of Medicine in Plzen Charles University Plzen Czech Republic

Department of Anesthesiology and Intensive Care University Clinical Hospital Center Zagreb Zagreb Croatia

Department of Anesthesiology and Post surgical Critical Care University Hospital Doctor Peset Valencia Spain

Department of Anesthesiology and Reanimation Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center University of Health Sciences Istanbul Turkey

Department of Anesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India

Department of Anesthesiology Intensive Care Medicine and Pain Therapy Evang Kliniken Essen Mitte Huyssens Stiftung Knappschaft Essen Germany

Department of Anesthesiology University Medical Center Groningen Groningen the Netherlands

Department of Cardiothoracic Surgery Interbalkan Medical Center Thessaloniki Greece

Department of Child General and Specialistic Surgery University of Campania Luigi Vanvitelli Naples Italy

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden

Department of Critical Care Asgar Ali Hospital Dhaka Bangladesh

Department of Critical Care Medicine Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India

Department of Epidemiology and Data Science Amsterdam University Medical Centre Amsterdam Public Health University of Amsterdam Amsterdam The Netherlands

Department of Intensive Care Adults Erasmus MC University Medical Centers Rotterdam the Netherlands

Department of Intensive Care Amsterdam University Medical Centers Amsterdam the Netherlands

Department of Intensive Care Centro Hospitalar de Entro o Douro e Vouga Santa Maria da Feira Portugal

Department of Intensive Care CHU Charleroi Marie Curie Charleroi Belgium

Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Copenhagen Denmark

Department of Intensive Care Inselspital Bern University Hospital and University of Bern Bern Switzerland

Department of Intensive Care Pontificia Universidad Católica de Chile Santiago Chile

Department of Respiratory Medicine National and Kapodistrian University of Athens Sotiria Chest Hospital Athens Greece

Division of Pulmonary Critical Care and Sleep Medicine University of New Mexico School of Medicine Albuquerque New Mexico USA

Faculty of Medicine University of Tripoli Tripoli Libya

Intensive Care Service Hospital Universitario La Paz Madrid Spain

Médecine Intensive Réanimation CHU de Brest Université de Bretagne Occidentale Brest France

Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK

School of Public Health and Preventive Medicine Monash University Melbourne Australia

The Australian and New Zealand Intensive Care Research Centre School of Public Health and Preventive Medicine Monash University Melbourne Australia

Unidad de Cuidados Intensivos Hospital Vicente Corral Moscoso Cuenca Ecuador

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