Platelet transfusion guidelines discourage prophylactic plasma transfusion for non-bleeding patients, yet findings from the International Point Prevalence Study of Intensive Care Unit Transfusion Practices (InPUT) study indicate that over one third of all intensive care unit (ICU) plasma transfusions are administered to non-bleeding patients. InPUT, a prospective observational cohort study, was conducted across 233 hospitals on six continents. Over a 16-week period from March 2020 to October 2022, all patients admitted to the ICU (n=3643) were followed for 28 days or until ICU discharge. Overall, 10% (356/3643) of patients received a least one plasma transfusion, including those receiving massive transfusion protocols (MTP), accounting for 18% of all transfusion events. The median number of plasma units transfused per event was two for non-MTP patients and three for MTP patients. Excluding MTPs, 54% of plasma transfusions were for actively bleeding patients, while 37% were for non-bleeding patients—25% prophylactic and 12% pre-procedure. Notably, the international normalized ratio (INR) or prothrombin time (PT) values were unreported in approximately a quarter of non-bleeding plasma transfusion events. Higher rates of plasma transfusion, including for non-bleeding patients, were found in Europe and Asia, and lower rates were observed in Oceania. Further research is needed to understand why plasma is administered not in alignment with guidelines and to evaluate its effectiveness in non-bleeding patients.
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