***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction Fresh frozen plasma ( FFP ) is widely used , but few studies have described patterns of plasma use in critical care . We carried out a multicentre study of coagulopathy in intensive care units ( ICUs ) and here describe overall FFP utilisation in adult critical care , the indications for transfusions , factors indicating the doses used and the effects of FFP use on coagulation . Methods We conducted a prospect i ve , multicentre , observational study of all patients sequentially admitted to 29 adult UK general ICUs over 8 weeks . Daily data throughout ICU admission were collected concerning coagulation , relevant clinical outcomes ( including bleeding ) , coagulopathy ( defined as international normalised ratio ( INR ) > 1.5 , or equivalent prothrombin time ( PT ) ) , FFP and cryoprecipitate use and indications for transfusion .  Results Of 1,923 admissions , 12.7 % received FFP in the ICU during 404 FFP treatment episodes ( 1,212 FFP units ) . Overall , 0.63 FFP units/ICU admission were transfused ( 0.11 units/ICU day ) . Reasons for FFP transfusion were bleeding ( 48 % ) , preprocedural prophylaxis ( 15 % ) and prophylaxis without planned procedure ( 36 % ) . Overall , the median FFP dose was 10.8 ml kg-1 , but doses varied widely ( first to third quartile , 7.2 to 14.4 ml kg-1 ) . Thirty-one percent of FFP treatments were to patients without PT prolongation , and 41 % were to patients without recorded bleeding and only mildly deranged INR ( < 2.5 ) . Higher volumes of FFP were administered when the indication was bleeding ( median doses : bleeding 11.1 ml kg-1 , preprocedural prophylaxis 9.8 ml kg-1 , prophylaxis without procedure 8.9 ml kg-1 ; P = 0.009 across groups ) and when the pretransfusion INR was higher ( ranging from median dose 8.9 ml kg-1 at INR ≤1.5 to 15.7 ml kg-1 at INR > 3 ; P < 0.001 across ranges ) . Regression analyses suggested bleeding was the strongest predictor of higher FFP dose . Pretransfusion INR was more frequently normal when the transfusion indication was bleeding . Overall , posttransfusion corrections of INR were consistently small unless the pretransfusion INR was > 2.5 , but administration during bleeding was associated with greater INR corrections . Conclusions There is wide variation in FFP use by ICU clinicians , and a high proportion of current FFP transfusions are of unproven clinical benefit . Better evidence from clinical trials could significantly alter patterns of use and modify current treatment costs UNLABELLED Bleeding is a feared complication of invasive procedures in patients with cirrhosis and significant coagulopathy ( as defined by routine coagulation tests ) and is used to justify preprocedure use of fresh frozen plasma ( FFP ) and /or platelets ( PLT ) . Thromboelastography ( TEG ) provides a more comprehensive global coagulation assessment than routine tests ( international normalized ratio [ INR ] and platelet count ) , and its use may avoid unnecessary blood product transfusion in patients with cirrhosis and significant coagulopathy ( defined in this study as INR > 1.8 and /or platelet count < 50 × 10(9 ) /L ) who will be undergoing an invasive procedure . Sixty patients were r and omly allocated to  TEG-guided transfusion strategy or st and ard of care ( SOC ; 1:1 TEG : SOC ) . The TEG group would receive FFP if the reaction time ( r ) was > 40 min and /or PLT if maximum amplitude ( MA ) was < 30 mm . All SOC patients received FFP and /or PLT per hospital guidelines . Endpoints were blood product use and bleeding complications . Baseline characteristics of the two groups were similar . Per protocol , all subjects in the SOC group received blood product transfusions versus 5 in the TEG group ( 100 % vs. 16.7 % ; P < 0.0001 ) . Sixteen SOC ( 53.3 % ) received FFP , 10 ( 33.3 % ) PLT , and 4 ( 13.3 % ) both FFP and PLT . In the TEG group , none received FFP alone ( P < 0.0001 vs. SOC ) , 2 received PLT ( 6.7 % ; P = 0.009 vs. SOC ) , and 3 both FFP and PLT ( not significant ) . Postprocedure bleeding occurred in only 1 patient ( SOC group ) after large-volume paracentesis . CONCLUSIONS In patients with cirrhosis and significant coagulopathy before invasive procedures , TEG-guided transfusion strategy leads to a significantly lower use of blood products compared to SOC ( transfusion guided by INR and platelet count ) , without an increase in bleeding complications . Remarkably , even in patients with significant coagulopathy , postprocedure bleeding was rare , indicating that TEG thresholds should be reevaluated Background Fresh frozen plasma ( FFP ) is an effective therapy to correct for a deficiency of multiple coagulation factors during bleeding . In past years , use of FFP has increased , in particular in patients on the Intensive Care Unit ( ICU ) , and has exp and ed to include prophylactic use in patients with a coagulopathy prior to undergoing an invasive procedure . Retrospective studies suggest that prophylactic use of FFP does not prevent bleeding , but carries the risk of transfusion-related morbidity . However , up to 50 % of FFP is administered to non-bleeding ICU patients . With the aim to investigate whether prophylactic FFP transfusions to critically ill patients can be safely omitted , a multi-center r and omized clinical trial is conducted in ICU patients with a coagulopathy undergoing an invasive procedure . Methods A non-inferiority , prospect i ve , multicenter r and omized open-label , blinded end point evaluation ( PROBE ) trial . In the intervention group , a prophylactic transfusion of FFP prior to an invasive procedure is omitted compared to transfusion of a fixed dose of 12 ml/kg in the control group . Primary outcome measure is relevant bleeding . Secondary outcome measures are minor bleeding , correction of International Normalized Ratio , onset of acute lung injury , length of ventilation days and length of Intensive Care Unit stay . Discussion The Transfusion of Fresh Frozen Plasma in non-bleeding ICU patients ( TOPIC ) trial is the first multi-center r and omized controlled trial powered to investigate whether it is safe to withhold FFP transfusion to coagulopathic critically ill patients undergoing an invasive procedure . Trial Registration Trial registration : Dutch Trial Register NTR2262 and Clinical Trials.gov : Objective : To determine the incidence of vascular complications associated with  central venous cannulation in patients with liver disease and coagulopathy . Design : A prospect i ve audit of all  cannulation episodes in patients with liver disease and a prothrombin ( INR ) more than 1.5 and /or platelet count of 150 × 109/l or less . Setting : A specialist liver unit between January 1996 and September 1997 . Patients : Patients with acute or chronic liver diseases and patients undergoing liver transplantation or other hepatobiliary surgery . Measurements and results : Vascular complications of central venous cannulation  were classified as major ( any haemodynamically significant haemorrhage ) or minor ( superficial oozing or haematoma ) . We recorded 658  cannulations  ( subclavian , 352 , and internal jugular , 306 ) . The median INR was 2.4 ( range 1–16 ) in the subclavian group and 2.7 ( 1–17 ) in the internal jugular group ( p < 0.05 ) ; median platelet counts were 81 × 109/l ( range 9–1088 ) and 83 × 109/l ( 10–425 ) , respectively ( difference not significant ) . One patient developed a haemothorax after accidental subclavian artery puncture ( INR was 1.5 , platelets 68 and regional prostacyclin therapy was being given for haemofiltration ) . There were no other major vascular complications . Risk factors for minor vascular complications included internal jugular cannulation , more than one needle pass into the vein , failure to pass any guidewire , a high INR and low platelets for haematoma formation , and low platelets and heparin therapy for superficial oozing . Conclusions : The incidence of major vascular complications following  central venous cannulation in patients with liver disease and coagulopathy was low in this audit . In liver disease the presence of a raised INR alone should not be considered a contra-indication to central venous cannulation Purpose To compare the complications experienced for 2 different br and s of  peripherally inserted central venous catheters ( PICC ) , Cook Turbo-Ject and the Bard PowerPICC Solo2 . The rationale for this project revolved around concern that one of the PICCS in question had high rates of complications . Methods A prospect i ve clinical trial was conducted after obtaining approval from the University of Saskatchewan Human Research Ethics Committee . All PICCs were implanted at the Royal University Hospital Medical Imaging Department by an interventional radiologist . Patient r and omization was achieved by alternating the br and of PICC implanted in sequential patients . All the subjects were in patients from a single surgical ward . Patients were excluded from the study if they had a known uncorrected coagulopathy , or if they were being treated for venous thrombosis . This project was financially supported by the Summer Student Research Fund , College of Medicine , University of Saskatchewan . Results A total of 53 PICCs ( 25 Bard and 28 Cook ) were inserted over the study period . The mean PICC dwell time was 23.3 days for both the Bard and Cook PICCs , respectively . No statistically significant differences were detected in study group demographics , technical placement of the PICCs , or in the complications encountered . Discussion Both the Cook Turbo-Ject and the Bard PowerPicc Solo2 PICCs provided acceptable venous access for a wide variety of clinical indications IMPORTANCE Severely injured patients experiencing hemorrhagic shock often require massive transfusion . Earlier transfusion with higher blood product ratios ( plasma , platelets , and red blood cells ) , defined as damage control resuscitation , has been associated with improved outcomes ; however , there have been no large multicenter clinical trials . OBJECTIVE To determine the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma , platelets , and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio . DESIGN , SETTING , AND PARTICIPANTS Pragmatic , phase 3 , multisite , r and omized clinical trial of 680 severely injured patients who arrived at 1 of 12 level I trauma centers in North America directly from the scene and were predicted to require massive transfusion between August 2012 and December 2013 . INTERVENTIONS Blood product ratios of 1:1:1 ( 338 patients ) vs 1:1:2 ( 342 patients ) during active resuscitation in addition to all local st and ard-of-care interventions ( uncontrolled ) . MAIN OUTCOMES AND MEASURES Primary outcomes were 24-hour and 30-day all-cause mortality . Prespecified ancillary outcomes included time to hemostasis , blood product volumes transfused , complications , incidence of surgical procedures , and functional status . RESULTS No significant differences were detected in mortality at 24 hours ( 12.7 % in 1:1:1 group vs 17.0 % in 1:1:2 group ; difference , -4.2 % [ 95 % CI , -9.6 % to 1.1 % ] ; P = .12 ) or at 30 days ( 22.4 % vs 26.1 % , respectively ; difference , -3.7 % [ 95 % CI , -10.2 % to 2.7 % ] ; P = .26 ) . Exsanguination , which was the predominant cause of death within the first 24 hours , was significantly decreased in the 1:1:1 group ( 9.2 % vs 14.6 % in 1:1:2 group ; difference , -5.4 % [ 95 % CI , -10.4 % to -0.5 % ] ; P = .03 ) . More patients in the 1:1:1 group achieved hemostasis than in the 1:1:2 group ( 86 % vs 78 % , respectively ; P = .006 ) . Despite the 1:1:1 group receiving more plasma ( median of 7 U vs 5 U , P < .001 ) and platelets ( 12 U vs 6 U , P < .001 ) and similar amounts of red blood cells ( 9 U ) over the first 24 hours , no differences between the 2 groups were found for the 23 prespecified complications , including acute respiratory distress syndrome , multiple organ failure , venous thromboembolism , sepsis , and transfusion-related complications . CONCLUSIONS AND RELEVANCE Among patients with severe trauma and major bleeding , early administration of plasma , platelets , and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days . However , more patients 
    Output:
    
It is not possible from the current RCT evidence to recommend whether or not prophylactic plasma transfusion is beneficial or harmful in this situation .