Use of Plasma in the Management of Central Nervous System Bleeding: Evidence-Based Consensus Recommendations

摘要: Central nervous system (CNS) hemorrhage is a potentially life-threatening condition, especially in patients with acquired coagulopathy. In this setting, treatment of CNS bleeding includes hemostatic therapy to replenish coagulation factors. There currently debate over the efficacy plasma many clinical settings, alongside increasing concern about transfusion-associated adverse events. Despite these concerns, widely used. Moreover, transfusion practice variable and there no uniform approach traumatic, surgical or spontaneous hemorrhage. This study addresses need for guidance on indications potential risks settings. An Expert Consensus Panel was convened develop recommendations guiding use treat and/or coagulopathy associated The panel did not advise best available but rather proposed be used formulation local procedures support emergency physicians their decision-making process. Evidence systematically gathered from literature rated using methods established by Scottish Intercollegiate Guidelines Network. evidence graded consensus recommendations, which are presented along evidence-based rationale each report. Sixty-five articles were identified covering both vitamin K antagonist-anticoagulation reversal bleeding/coagulopathy non-anticoagulated patients. Recommendations then developed four scenarios within area, agreed unanimously all members panel. considered reasonable requiring urgent correction coagulopathy, although should prepared cardiopulmonary complications, suggests that alternative therapies have superior risk–benefit profiles. Plasma could recommended absence Consideration absolute benefits before imperative.