Fresh Frozen Plasma versus Albumin in Treatment of Cerebral Vasospasm in Subarachnoid Hemorrhage: A Historical Cohort Study

Abdolkarim Rahmanian, Alireza Mohsenian Sisakht, Nima Derakhshan, Najme Karamzade Ziarati, Hadi Raeisi Shahraki, Bijan Najafi and Babak Daneshfard

Department of Neurosurgery, Shiraz University of Medical Sciences, Iran
Student Research committee, Iran University of Medical Sciences, Iran
Student Research Committee, Tehran University of Medical Sciences, Iran
Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Iran
Student research committee, Shiraz University of Medical Sciences, Iran

^*Correspondance to: Nima Derakhshan 

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Abstract:

Background: Patients with Subarachnoid Hemorrhage (SAH) are susceptible of developing cerebral vasospasm, and intravascular volume expansion remains one of the mainstays of treatment. Albumin has been introduced as the customary volume expander agent for prevention and treatment of cerebral vasospasm; however Fresh Frozen Plasma (FFP) with its rich protein content is also a reasonable substitute for albumin. Unfortunately, albumin solution was not as available as recently till 2011 and prior to that, FFP was used instead, as a common means of inducing hypervolemia in patients sustaining cerebral vasospasm, in many source-limiting areas, such as southern Iran.
Objectives: To compare FFP transfusion vs. albumin infusion in terms of functional outcome and thrombo-embolic events in patients with aneurysmal SAH.
Methods: Analysis of 474 patients with aneurysmal SAH who underwent surgical clipping between September 2007 and March 2016, in Shiraz Nemazee Hospital (southern Iran) affiliated in Shiraz Nemazee Hospital was carried out in a retrospective fashion. The functional outcome and also incidence of venous thrombo-embolic events including Deep Vein Thrombosis (DVT) and Pulmonary Thrombo-Embolism (PTE) were assessed and compared between the two subgroups of patients taking FFP transfusion vs. albumin infusion.
Results: Functional outcome was better in patients taking albumin infusion; however there was no difference in the rate of thrombo-embolic events between the two groups.
Conclusion: Albumin is considered the standard of care for hypervolemic therapy in cerebral vasospasm; in source-limited areas FFP can be considered an inexpensive alternative to albumin without further increment in thrombo-embolic events. However, the use of volume expanders should only be considered in angiographic spasm and prophylactic usage is not a common practice anymore.

Keywords:

Aneurysmal SAH; Cerebral vasospasm; Fresh frozen plasma; Albumin; PTE; DVT

Cite the Article:

Rahmanian A, Sisakht AM, Derakhshan N, Ziarati NK, Shahraki HR, Najafi B, et al. Fresh Frozen Plasma versus Albumin in Treatment of Cerebral Vasospasm in Subarachnoid Hemorrhage: A Historical Cohort Study. World J Surg Surgical Res. 2018; 1: 1002.