Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials.

Yang et al. systematically review all randomized controlled trials on the effectiveness of fresh-frozen plasma (FFP) published since the original review on this topic published in 2004. Since 2004, 21 new RCTs have been published with 8 more studies ongoing and 4 that have been recently completed but not yet published. Thus, in total, 80 studies have been completed and published in this area over the past 50 years. Most of these studies have focused on patients with liver and cardiac disease/surgery.

As in 2004, there was no significant benefit of FFP use across all clinical conditions studied (liver disease, cardiac surgery, reversal of warfarin anticoagulation, treatment of TTP, plasmapheresis, burns, shock, head injury, etc.). Combined with the 2004 review, FFP shows no significant benefit for prophylactic or therapeutic use across all indications studied. Of note, the overall methodological quality of studies is poor.

In summary, the effectiveness of FFP remains elusive, despite its widespread use in different clinical contexts. FFP carry a substantial risk of complications and more high-quality trials are required to determine the benefit/risk ratio of this therapeutic modality.

– Jean-François Hardy