HealthDay News – About 20% of patients administered fresh frozen plasma (FFP) to reverse warfarin anticoagulation develop pulmonary complications, with highest risk seen with more than 3 units of FFP, according to a study published online December 8 in the Journal of Thrombosis and Haemostasis.

Ariela Marshall, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues examined the incidence and dose relationship of pulmonary complications, including transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI), in 251 patients receiving FFP for warfarin reversal.

The researchers found that 20% of patients developed pulmonary complications, including 12% TACO, 1% TRALI, and 7% pulmonary edema that did not meet the criteria for TACO. Patients who received more than 3 units of FFP had pulmonary complications significantly more frequently (34% vs 15.6%; P=.006). Only the risk of TACO was significant on stratification by subtype of complication (28.3% vs 7.6%; P=.0002). After controlling for age, sex, initial systolic blood pressure, and intravenous fluids given in the emergency department, receipt of more than 3 units of FFP remained significantly associated with pulmonary complications (odds ratio, 2.49; P=.01).

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“Almost 20% of patients who received FFP for warfarin reversal developed pulmonary complications, primarily TACO, and this risk increased with greater than three units of FFP,” the authors wrote.


Marshall A, Levine M, Howell ML, et al. Dose-associated pulmonary complication rates after fresh frozen plasma administration for warfarin reversal. J Thromb Haemost. 2015. doi: 10.1111/jth.13212.