Introduction and aim of the work: Fresh frozen plasma (FFP) is frequently transfused prior to the invasive procedure in patients with ‎significant coagulopathy to reduce presumed high bleeding risk. The work aimed to assess the ‎efficacy of prophylactic FFP transfusion before the invasive procedures in cirrhotic patients with ‎severe coagulopathy‎‎.‎
Patients and Methods: ‎‎A prospective study enrolled 42 adult patients with cirrhosis and severe coagulopathy as defined by ‎deranged coagulation test INR ≥ 2, who was planned to have an invasive procedure. The patients ‎were recruited from the hospitalized or endoscopy list of the Nizwa General Hospital from January 2021 to ‎January 2022. patients were randomized to receive FPP transfusion 6 hours before a procedure at a ‎dose of 10 cc per kg (group A) or no transfusion (group B). The following outcomes were traced; ‎transfusion side effects, INR levels before and after FFP transfusion, post-procedure bleeding ‎incidence, INR and hemoglobin level changes from the baseline levels for two days.‎
Results: The change of INR after FFP transfusion was significantly higher in group A than in group B (- 0.38 ‎‎± 0.22 vs. - 0.02 ± 0.08 respectively) and continued over the consecutive two days post-procedure ‎two patients had procedure-related bleeding in Group B with a significant hemoglobulin drop of ≥ 2 ‎gm compared to one patient in group A  (p > 0.05)‎‎‎‎‎.
Conclusion: FPP transfusion decreases INR significantly but with no apparent significant impact on bleeding ‎incidence, suggesting transfusion to be conducted on an individual basis in high-risk cirrhotic ‎patients before invasive procedures‎‎‎‎‎‎‎‎‎.