{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T17:22:27Z","timestamp":1784740947765,"version":"3.55.0"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T00:00:00Z","timestamp":1705449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Platelets (PLTS) and fresh frozen plasma (FFP) are often transfused in cardiac surgery patients for perioperative bleeding. Their relative effectiveness is unknown.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted an entropy-weighted retrospective cohort study using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. All adults undergoing cardiac surgery between 2005\u20132021 across 58 sites were included. The primary outcome was operative mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 174,796 eligible patients, 15,360 (8.79%) received PLTS in the absence of FFP and 6,189 (3.54%) patients received FFP in the absence of PLTS. The median cumulative dose was 1 unit of pooled platelets (IQR 1 to 3) and 2 units of FFP (IQR 0 to 4) respectively. After entropy weighting to achieve balanced cohorts, FFP was associated with increased perioperative (Risk Ratio [RR], 1.63; 95% Confidence Interval [CI], 1.40 to 1.91; P&lt;0.001) and 1-year (RR, 1.50; 95% CI, 1.32 to 1.71; P&lt;0.001) mortality. FFP was associated with increased rates of 4-hour chest drain tube output (Adjusted mean difference in ml, 28.37; 95% CI, 19.35 to 37.38; P&lt;0.001), AKI (RR, 1.13; 95% CI, 1.01 to 1.27; P = 0.033) and readmission to ICU (RR, 1.24; 95% CI, 1.09 to 1.42; P = 0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In perioperative bleeding in cardiac surgery patient, platelets are associated with a relative mortality benefit over FFP. This information can be used by clinicians in their choice of procoagulant therapy in this setting.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0296726","type":"journal-article","created":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T18:27:56Z","timestamp":1705516076000},"page":"e0296726","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7764-0741","authenticated-orcid":true,"given":"Jake V.","family":"Hinton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7582-9145","authenticated-orcid":true,"given":"Calvin M.","family":"Fletcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke A.","family":"Perry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3067-7154","authenticated-orcid":true,"given":"Noah","family":"Greifer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica N.","family":"Hinton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenni","family":"Williams-Spence","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5805-5491","authenticated-orcid":true,"given":"Reny","family":"Segal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian A.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9173-3944","authenticated-orcid":true,"given":"Christopher M.","family":"Reid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7403-7680","authenticated-orcid":true,"given":"Laurence","family":"Weinberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinaldo","family":"Bellomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,1,17]]},"reference":[{"issue":"4","key":"pone.0296726.ref001","doi-asserted-by":"crossref","first-page":"409","DOI":"10.3390\/surgeries2040041","article-title":"Fibrinogen and Bleeding in Adult Cardiac Surgery: A Review of the Literature.","volume":"2","author":"V Iki\u0107","year":"2021","journal-title":"Surgeries"},{"issue":"4","key":"pone.0296726.ref002","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.gheart.2018.08.002","article-title":"Global Unmet Needs in Cardiac Surgery.","volume":"13","author":"P Zilla","year":"2018","journal-title":"Glob Heart"},{"issue":"5","key":"pone.0296726.ref003","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1016\/j.jtcvs.2013.10.051","article-title":"Transfusion practice varies widely in cardiac surgery: Results from a national registry","volume":"147","author":"ZK McQuilten","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"pone.0296726.ref004","unstructured":"National Blood Authority. Clinical Indications for Fresh Frozen Plasma 2011 [Available from: https:\/\/www.blood.gov.au\/system\/files\/documents\/companion-26-pbm-guidelines.pdf."},{"key":"pone.0296726.ref005","article-title":"Clinical Indications for Platelets.","author":"National Blood Authority.","year":"2011","journal-title":"Patient Blood Management Guidelines"},{"issue":"5\u20136","key":"pone.0296726.ref006","doi-asserted-by":"crossref","first-page":"197","DOI":"10.3109\/10408363.2010.549291","article-title":"The coagulopathy of cardiopulmonary bypass","volume":"47","author":"MW Besser","year":"2010","journal-title":"Crit Rev Clin Lab Sci"},{"issue":"5","key":"pone.0296726.ref007","first-page":"824","article-title":"Mechanism of Abnormal Bleeding in Patients Undergoing Cardiopulmonary Bypass: Acquired Transient Platelet Dysfunction Associated with Selective a-granule Release","volume":"56","author":"L Harker","year":"1985","journal-title":"Blood"},{"issue":"11","key":"pone.0296726.ref008","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1053\/j.jvca.2023.08.001","article-title":"Red Blood Cell Transfusion Guided by Hemoglobin Only or Integrating Perfusion Markers in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis With Trial Sequential Analysis.","volume":"37","author":"A Putaggio","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"4","key":"pone.0296726.ref009","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1053\/j.jvca.2020.07.050","article-title":"Point-of-Care Platelet Function Monitoring: Implications for Patients With Platelet Inhibitors in Cardiac Surgery.","volume":"35","author":"D Bolliger","year":"2021","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"pone.0296726.ref010","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2147\/JMDH.S232888","article-title":"Bleeding Management Practices of Australian Cardiac Surgeons, Anesthesiologists and Perfusionists: A Cross-Sectional National Survey Incorporating the Theoretical Domains Framework (TDF) and COM-B Model.","volume":"13","author":"BL Pearse","year":"2020","journal-title":"J Multidiscip Healthc"},{"key":"pone.0296726.ref011","first-page":"117","article-title":"Appropriateness of platelet, fresh frozen plasma and cryoprecipitate transfusion in New South Wales public hospitals","volume":"178","author":"W Schofield","year":"2003","journal-title":"MJA"},{"issue":"2","key":"pone.0296726.ref012","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1177\/1556984519836839","article-title":"Variation in Platelet Transfusion Practices in Cardiac Surgery.","volume":"14","author":"X Zhou","year":"2019","journal-title":"Innovations (Phila)."},{"issue":"2","key":"pone.0296726.ref013","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/j.1537-2995.2010.02816.x","article-title":"Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients","volume":"51","author":"G Li","year":"2011","journal-title":"Transfusion"},{"issue":"6","key":"pone.0296726.ref014","doi-asserted-by":"crossref","DOI":"10.1016\/j.athoracsur.2012.11.078","article-title":"Blood transfusion and infection after cardiac surgery","volume":"95","author":"KA Horvath","year":"2013","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"pone.0296726.ref015","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.athoracsur.2008.04.051","article-title":"Platelet transfusion in cardiac surgery does not confer increased risk for adverse morbid outcomes","volume":"86","author":"T McGrath","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"pone.0296726.ref016","author":"G Shardey","year":"2019"},{"key":"pone.0296726.ref017","author":"Australian Red Cross Lifeblood","year":"2020","journal-title":"Blood Component Information: An Extension of Blood Component Labels"},{"key":"pone.0296726.ref018","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jclinepi.2019.02.016","article-title":"The proportion of missing data should not be used to guide decisions on multiple imputation.","volume":"110","author":"P Madley-Dowd","year":"2019","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"pone.0296726.ref019","first-page":"1","article-title":"mice: Multivariate imputation by chained equations in R","volume":"45","author":"S Van Buuren","year":"2011","journal-title":"Journal of statistical software"},{"issue":"1","key":"pone.0296726.ref020","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/pan\/mpr025","article-title":"Entropy Balancing for Causal Effects: A Multivariate Reweighting Method to Produce Balanced Samples in Observational Studies","volume":"20","author":"J. Hainmueller","year":"2017","journal-title":"Political Analysis"},{"issue":"4","key":"pone.0296726.ref021","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity Analysis in Observational Research: Introducing the E-Value","volume":"167","author":"TJ VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"pone.0296726.ref022","author":"N. Greifer","year":"2022","journal-title":"Weighting for covariate balance in observational studies"},{"issue":"9","key":"pone.0296726.ref023","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1111\/j.1445-5994.2008.01730.x","article-title":"Use of fresh-frozen plasma at Royal Darwin Hospital: a retrospective audit","volume":"38","author":"S Moylan","year":"2008","journal-title":"Intern Med J"},{"issue":"7","key":"pone.0296726.ref024","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1007\/s00134-010-1867-8","article-title":"Transfusion practice and guidelines in Australian and New Zealand intensive care units","volume":"36","author":"A Westbrook","year":"2010","journal-title":"Intensive Care Med"},{"issue":"12","key":"pone.0296726.ref025","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1001\/jama.288.12.1499","article-title":"Anemia and blood transfusion in critically ill patients","volume":"288","author":"J Vincent","year":"2002","journal-title":"JAMA"},{"issue":"1","key":"pone.0296726.ref026","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/01.CCM.0000104112.34142.79","article-title":"The CRIT Study: Anemia and blood transfusion in the critically ill\u2014current clinical practice in the United States","volume":"32","author":"HL Corwin","year":"2004","journal-title":"Crit Care Med"},{"issue":"15","key":"pone.0296726.ref027","doi-asserted-by":"crossref","DOI":"10.3390\/s20154254","article-title":"Point-of-Care Diagnostics in Coagulation Management","volume":"20","author":"SD Sahli","year":"2020","journal-title":"Sensors (Basel)."},{"issue":"3","key":"pone.0296726.ref028","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.athoracsur.2021.06.061","article-title":"Number and Type of Blood Products Are Negatively Associated With Outcomes After Cardiac Surgery.","volume":"113","author":"N Ad","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"pone.0296726.ref029","article-title":"Transfusion of non-red blood cell blood products does not reduce survival following cardiac surgery","author":"V Bianco","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"4","key":"pone.0296726.ref030","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1053\/j.jvca.2022.12.009","article-title":"Platelet Transfusion After Cardiac Surgery.","volume":"37","author":"CM Fletcher","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"pone.0296726.ref031","article-title":"How should we treat acute kidney injury caused by renal congestion?","author":"M Abe","year":"2023","journal-title":"Kidney Res Clin Pract"},{"issue":"8","key":"pone.0296726.ref032","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1111\/j.1537-2995.2011.03515.x","article-title":"Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials","volume":"52","author":"L Yang","year":"2012","journal-title":"Transfusion"},{"issue":"1","key":"pone.0296726.ref033","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/anae.15070","article-title":"Contributors. The incidence and effect of resternotomy following cardiac surgery on morbidity and mortality: a 1-year national audit on behalf of the Association of Cardiothoracic Anaesthesia and Critical Care.","volume":"76","author":"S Agarwal","year":"2021","journal-title":"Anaesthesia"},{"issue":"16","key":"pone.0296726.ref034","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1001\/jama.2023.4221","article-title":"Emulation of Randomized Clinical Trials With Nonrandomized Database Analyses: Results of 32 Clinical Trials.","volume":"329","author":"SV Wang","year":"2023","journal-title":"JAMA"},{"issue":"7","key":"pone.0296726.ref035","first-page":"CD007614","article-title":"Fresh frozen plasma for cardiovascular surgery","volume":"2015","author":"M Desborough","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"pone.0296726.ref036","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/trf.12918","article-title":"Transfusion-related adverse reactions reported to the National Healthcare Safety Network Hemovigilance Module, United States, 2010 to 2012","volume":"55","author":"AR Harvey","year":"2015","journal-title":"Transfusion"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296726","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T18:28:15Z","timestamp":1705516095000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296726"}},"subtitle":[],"editor":[{"given":"Luigi","family":"La Via","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,1,17]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0296726","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,17]]}}}