Fresh frozen plasma in dengue patients with altered coagulation parameters: A randomized trial

Abstract

Objective: To evaluate the effects of fresh frozen plasma transfusion in dengue patients.

Methods: In this randomised, double blind, parallel, controlled trial, we included 200 patients with activated partial thromboplastin time (APTT) ≥40 seconds and platelet count ≤50×10⁹/L, randomly assigning them to experimental (10-15 mL/kg fresh frozen plasma transfusion) or control (standard management) groups. The principal aim was to assess the alteration in APTT at 24 hours among such patients. Between-group comparisons were restricted to the initial 24 hours post-intervention. Owing to ethical concerns regarding bleeding necessitating rescue therapy, the control group was removed, and subsequent follow-up (48 hours and 7 days post-transfusion) continued only for the experimental group.

Results: Baseline characteristics in both groups were comparable. Mean age was (34.1±8.1) years and (36.1±7.8) years in the experimental and control groups, respectively. Within 24 hours, the experimental group had a significant drop in APTT compared to controls [median 38 (IQR 36-40) seconds vs. 44 (IQR 4046) seconds; P<0.001)]. Platelet count, mean haemoglobin, and haematocrit levels rose significantly in the experimental group (P<0.001). Thirty (30%) control patients developed active bleeding, while none in the experimental group. Follow-up of the experimental arm showed significant sustained APTT reduction and platelet count increase.

Conclusions: Fresh frozen plasma transfusion improves coagulation markers (reducing APTT and thrombocytopenia) at short-term (24 hours). Assessing use of fresh frozen plasma to prophylactically prevent active bleeding in severe dengue needs more studies with long-term follow-up. (ClinicalTrials.gov number, NCT06642493.)

Keywords

Dengue / Severe dengue / Fresh frozen plasma / Dengue haemorrhagic fever / Dengue shock syndrome / Activated partial thromboplastin time (APTT) / Thrombocytopenia / Platelet

Conflict of interest statement

None of the contributing authors declare any conflicts of interest.

Funding

The authors received no extramural funding for the study.

Authors' contributions

Conceptualization: A.H. and S.K.B.; Methodology: A.H. and M.A.; Data-collection: A.H., S.K.B., M.A. and S.M.C.; Formal analysis: M.A. and S.M.C.; Investigation: A.H., S.K.B., M.U.H. and A.A.M.; Resources: A.H., S.K.B., M.U.H., M.A., S.M.C. and A.A.M.; Data curation, A.H., M.A. and S.M.C; Writing/ Drafting—original draft, M.A.; Writing—review and editing, A.H., S.K.B., M.U.H. and A.A.M.; Critical Revision/ supervision: A.H., A.A.M. and S.K.B.; Project administration: A.H. and M.A. All authors have read and agreed to the published version of the manuscript.

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Edited by Lei Y, Pan Y, Zhang Q

Acknowledgements

The authors would like to express their sincere gratitude to Prof. Dr. Rayhana Awwal Sumi, Ex-Director of the Sheikh Hasina National Institute of Burn & Plastic Surgery, Bangladesh, for her invaluable guidance, continuous support, and encouragement throughout the course of this work.

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