Evidence for a rationale use of frozen plasma for the treatment and prevention of bleeding

Frozen plasma is a commonly used blood product. The primary indication for frozen plasma is the treatment and prevention of bleeding in patients with prolonged coagulation tests. Unfortunately, there is a lack of well conducted clinical trials to determine the appropriate indications for frozen plasma and, as a result, a large proportion of frozen plasma transfusions are inappropriate according to current guidelines. As an alternative approach to foster improved transfusion practice, we outline a recently described paradigm for the use of frozen plasma to prevent and treat bleeding: (1) prolonged coagulation tests increase the risk of bleeding, (2) frozen plasma will correct abnormal coagulations and (3) correcting abnormal coagulation with frozen plasma transfusions will reduce bleeding. However, the evidence does not support either of the first two tenets, which suggests that transfusing frozen plasma will not reduce bleeding in some situations. Targeting these situations may allow an opportunity to improve current utilization of frozen plasma.