Peri-Interventional Prophylactic Plasma Transfusion

Human plasma remains one of the most frequently transfused blood products despite increasing data that many transfusions are unnecessary and unsupported by clinical evidence. This review summarises current evidence regarding the haemostatic properties of therapeutic plasma, their effects on conventional coagulation tests, and contemporary use in non-bleeding patients undergoing surgery or invasive procedures, as well as for anticoagulant reversal. Conventional coagulation tests, particularly the international normalised ratio (INR), correlate poorly with bleeding risk and are only minimally corrected by commonly administered plasma doses. Current evidence demonstrates that prophylactic plasma transfusion does not reduce peri-procedural bleeding in most patients while exposing them to transfusion-related complications which can lead to worse outcomes. Recent international guidelines consistently discourage routine plasma transfusion solely to correct mildly abnormal coagulation tests, and recommend four-factor prothrombin complex concentrate rather than plasma for urgent vitamin K antagonist reversal.