PB1010 - Impact of fresh frozen plasma dosing in patients with a left ventricular assist device undergoing heart transplant

Background: Warfarin is used in left ventricular assist device (LVAD) patients for the prevention of pump thrombosis. In the setting of bridge-to-transplant, warfarin reversal must be accomplished quickly when a heart becomes available. Although fresh frozen plasma (FFP) is commonly dosed at 10mL/kg, dosing in this setting is not well defined.

Aims: Evaluate dosing of FFP [ < 10mL/kg=low-dose (LD) vs. ≥10mL/kg=high-dose (HD)] on time to surgery, blood product use, and clinical outcomes post-surgery.

Methods: In this retrospective study we identified LVAD patients undergoing heart transplant at our institution. Only patients receiving FFP prior to surgery were included. Data collection included baseline characters, surgical timing and blood product use, post-surgical management, and 30-day outcomes. Categorical data was evaluated using chi-square analysis and continuous data was evaluated using student’s t-test.

Results: We identified 153 eligible patients (n=73 received LD and n=80 received HD) from 9/2012 to 4/2021. All patients also received vitamin K 10 mg. Mean dose of FFP was significantly different between the groups (6.6±2.0 mL/kg vs. 14.7±4.0; p< 0.001). No differences were noted in baseline characteristics (Table). Although baseline INR was similar, HD-FFP provided a significant reduction in INR prior to surgery (1.6±0.3 vs. 1.4±0.2; p< 0.001). There was also 25% absolute reduction in an INR >1.4 at the time of surgery with HD-FFP (Table) Patients receiving HD-FFP went to surgery about 2 hours quicker than those receiving LD-FFP. There were also significant reductions in blood loss and red cell transfusion during surgery with HD-FFP. Chest tube drainage was significantly less with HD-FFP on the day of surgery and total over 5-days. Clinical outcomes were similar between groups (Table).

Conclusion(s): HD-FFP provides several benefits in LVAD patients undergoing heart transplant compared to LD-FFP, although clinical outcomes are not altered. Larger, multicenter studies will help confirm that these patients should receive at least 10mL/kg of FFP.