***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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    ***EXAMPLES*** 
    Input: BACKGROUND Recent military experience suggests that immediate 1:1 fresh frozen plasma ( FFP ) ; red blood cells ( RBC ) for casualties requiring > 10 units packed red blood cells ( RBC ) per 24 hours reduces mortality , but no clinical trials exist to address this issue . Consequently , we review ed our massive transfusion practice s during a 5-year period to test the hypothesis that 1:1 FFP : RBC within the first 6 hours reduces life threatening coagulopathy . METHODS We queried our level I trauma center 's prospect i ve registry from 2001 to 2006 for patients undergoing massive transfusion . Logistic regression was used to evaluate the independent effect of FFP : RBC in 133 patients who received > 10 units RBC in 6 hours on ( 1 ) Coagulopathy ( international normalized ratio [ INR ] > 1.5 at 6 hours ) , controlling for our previously described risk factors predictive of coagulopathy , as well as RBC , FFP , and platelet administration ( 2 ) Death ( controlling for all variables plus age , crystalloids per 24 hours , INR > 1.5 at 6 hours ) . RESULTS Overall mortality was 56 % ; 50 % died from acute blood loss in the operating room . Over 80 % of the RBC transfusions were completed in the first 6 hours : ( Median RBC : 18 units ) Median FFP : RBC survivors , 1:2 , nonsurvivors : 1:4 . ( p < 0.001 ) INR > 1.5 at 6 hours occurred in 30 ( 23 % ) ; 81 % died . Regarding mortality , logistic regression showed significant variables ( p < 0.05 ) included : RBC per 6 hours ( OR = 1.248 , 95%CI : 1.957 - 53.255 ) , INR at 6 hours > 1.5 ( OR = 10.208 , 95 % CI : 1.957 - 53.255 ) , ED temperature < 34 degrees C ( OR = 15.491 , 95 % CI 1.376 - 174.396 ) , and age > 55 years ( OR = 40.531 , CI 5.315 - 309.077 ) . The adjusted OR for FFP : RBC ratio including the quadratic term was found to follow a U-shaped association ( quadratic term estimate 0.6737 + /- 0.0345 , p = 0.0189 ) . CONCLUSION Although our data suggest that 1:1 FFP : RBC reduced coagulopathy , this did not translate into a survival benefit . Our findings indicate that the relationship between coagulopathy and mortality is more complex , and further clinical investigation is necessary before recommending routine 1:1 in the exsanguinating trauma patient Early changes in coagulation were found in patients following a paracetamol overdose . Low levels of clotting factors II , V and VII were present within 24 hours of the overdose . As the levels of factor II correlated with plasma fibrinogen values at this time , it is possible that they were consumed in the process of intravascular coagulation , although this was not supported by the presence of raised titres of fibrin degradation products . The prothrombin time ratio was greater than 2 - 2 within 30 hours of ingestion of the overdose in all patients who eventually died , whereas it was less than this in those developing only moderate liver damage . The administration of fresh frozen plasma to patients did appear to reduce the maximum abnormality of the prothrombin time ratio , which was significantly less three days after the overdose in the group receiving fresh frozen plasma . However , the coagulation disturbance was of short duration , and the prothrombin time ratio had also returned to normal within one week of the overdose in the control patients , and the administration of fresh frozen plasma did not appear to reduce the morbidity or mortality in the treated patients Background and Purpose — Patients treated with oral anticoagulants ( ACs )  have an increased risk of intracerebral hemorrhage ( ICH ) , which is more often fatal than spontaneous ICH . Options to reverse the AC effect include intravenous administration of vitamin K , plasma , and coagulation factor concentrate . However , the optimal management of AC-related ICH has not been determined in any r and omized trial . In this study , the present management of AC-related ICH was surveyed , and determinants of survival were assessed . Methods — We retrospectively review ed the medical records of all AC-related ICHs at 10 Swedish hospitals during a 4-year period , 1993 to 1996 .  Survival status after the ICH was determined from the Swedish National population register . Results — We identified 151 patients with AC-related ICH .  Death rates were 53.6 % at 30 days , 63.6 % at 6 months , and 77.5 % at follow-up ( mean 3.5 years ) . The case fatality ratio at 30 days was 96 % among patients unconscious on admission ( n=27 ) , 80 % among patients who became unconscious before active treatment was started ( n=15 ) , 55 % among patients in whom no special action was taken except withdrawal of AC treatment ( n=42 ) , and 28 % among patients given active anti-coumarin treatment while they were still conscious ( n=64 ) . The case fatality ratio at 30 days was 11 % in the group treated with plasma ( n=18 ) , 30 % in the group treated with vitamin K ( n=23 ) , and 39 % in the group treated with coagulation factor concentrate ( n=23 ) . Within the first 24 to 48 hours after admission , 47 % of the patients deteriorated . Choice of therapy to reverse the AC effect differed substantially between the hospitals ( P < 0.0001 ) , as did the time interval from symptom onset to start of treatment . Multiple logistic regression analysis showed only 2 factors ( intraventricular extension of bleeding and ICH volume ) that were independently related to case fatality at both 30 days and 6 months . The results were similar when the analysis was restricted to patients who were conscious on admission . Conclusions — In AC-related ICH , a progressive neurological deterioration during the first 24 to 48 hours after admission is frequent , and the mortality is high . Choice of therapy to reverse the AC effect differed considerably between the hospitals . There was no evidence that any treatment strategy was superior to the others . A r and omized controlled trial is needed to determine the best choice of treatment Objectives : Recent data from Iraq supporting early aggressive use of fresh frozen plasma ( FFP ) in a 1:1 ratio to packed red blood cells ( PRBCs ) has led many civilian trauma centers to adopt this re source intensive strategy . Methods : Prospect i ve data were collected on 806 consecutive trauma patients admitted to the intensive care unit over 2 years . Patients were stratified by PRBC : FFP transfusion ratio over the first 24 hours . Stepwise regression models were performed controlling for age , gender , mechanism of injury , injury severity , and acute physiology and chronic health evaluation ( APACHE ) 2 score to determine if early aggressive use of PRBC : FFP improved outcome . Results : Seventy-seven percent of patients were male ( N = 617 ) and 85 % sustained blunt injury ( n = 680 ) . Mean age , injury severity score ( ISS ) , and APACHE score were 43 ± 20 years , 29 ± 13 , and 13 ± 7 , respectively . Mean number of PRBCs and FFP transfused were 7.7 ± 12 U , 6 U , and 5 ± 12 U , respectively . Three hundred sixty-five ( 45 % ) patients were transfused in the first 24 hours . Sixty-eight percent ( n = 250 ) of them received both PRBCs and FFP . Analyzing these patients by stepwise regression controlling for all significant variables , the PRBC : FFP ratio did not predict intensive care unit days , hospital days , or mortality even in patients who received massive transfusion ( ≥10 U ) . Furthermore , there was no significant difference in outcome when comparing patients who had a 1:1 PRBC : FFP ratio with those who did not receive any FFP . Conclusion : Early and aggressive use of FFP does not improve outcome  after civilian injury . This may reflect inherent differences compared with military injury ; however , this practice should be reevaluated A prospect i ve , controlled and r and omized study of 275 patients undergoing major surgery was performed to investigate if postoperative complications were influenced by restrictive use of plasma to replace operative blood loss . All patients were given 6 % dextran ( Macrodex ) for thromboprophylaxis and haemodilution . The " Dextran Group " received equal amounts of 6 % dextran and electrolyte solution as substitution for plasma loss . The need for red-cell transfusion ( 60 % suspension in saline-adenine-glucose-mannitol storage medium ) averaged 5.8 units in this group and 5.2 in the " Plasma Group " . The respective mean totals of infused plasma and dextran  were 400 ml and 1,383 ml in the Dextran Group , compared with 1,099 and 619 ml in the Plasma Group . The mean total electrolyte infusion in the first postoperative week was c. 7,500 ml in both groups . Serum albumin decreased considerably in both groups , but significantly more in the Dextran Group . The incidence and pattern of postoperative complications were similar in both groups . When blood loss is up to 50 - 60 % of the total volume , Macrodex can be used in preference to plasma , unless administration of plasma protein is specifically indicated Patients on warfarin for mechanical heart valves are at increased risk for thromboembolic events and intracranial hemmorhage . In current guidelines , a low dose of vitamin K is the recommended treatment for moderate over-anticoagulation based on studies in which only minority patients participating had mechanical heart valves . We performed a r and omized controlled trial to compare the efficacy and safety profile of low-dose intravenous vitamin K and fresh frozen plasma ( FFP ) for patients with mechanical heart valves and mild to moderate over-anticoagulation ( international normalized ratio [ INR ] 4 to 7 ) . In a 24-month period , we r and omized 102 patients to ( 1 ) vitamin K or ( 2 ) FFP . The baseline INR  at presentation between the  vitamin K group and the FFP group was 4.61 + /- 0.007 vs 4.78 + /- 0.07 ( p = 0.11 ) . Six hours after treatment , patients in the FFP group had a significantly lower mean INR compared with the vitamin K group ( 2.75 + /- 0.06 vs 3.44 + /- 0.10 , p = 0.01 ) . No patient in both groups had over-correction ( INR < 2 ) . One week later , there was no significant difference in mean INR between both groups ( 2.7 + /- 0.11 vs 2.56 + /- 0.12 , p = 0.41 ) . Fifty-eight percent of patients in the FFP group and 51 % in the vitamin K group had an INR within the target range . There were no adverse reactions or outcomes in both groups . In conclusion , intravenous low-dose vitamin K is a safe alternative to FFP infusion for warfarin overdose in patients with mechanical heart valves Background Previous studies failed to demonstrate any benefit from prophylaxis with fresh frozen plasma ( FFP ) after cardiopulmonary bypass ( CPB ) . The results , however , were limited by either retrospective study design or use of FFP in subtherapeutic doses ( 2–3 units ) . The authors evaluated whether a therapeutic dose ( 15 ml/kg ) of FFP reduces blood loss and transfusion requirements in elective coronary artery bypass surgery . The risks of multiple allogeneic blood donor exposure were circumvented by using autologous plasma . Methods Sixty adult patients scheduled for elective primary coronary artery bypass grafting were r and omized to receive , after CPB , an intravenous infusion of 15 ml/kg of either autologous FFP ( 30 patients ) or 6 % hydroxyethyl starch 450/0.7 ( HES ; 30 patients ) . Autologous plasma was obtained by platelet-poor plasmapheresis several weeks before surgery . Perioperative blood transfusions were administered per protocol . Postoperative blood loss was defined as the chest tube drainage during the first 24 h after surgery . Results The data from 56 patients ( FFP group , 27 patients ; HES group , 29 patients ) who completed the study according to protocol were analyzed . Median postoperative blood loss was 630 ml ( range , 450–1,840 ml ) and 830 ml ( range , 340–1,980 ml ) in the FFP and HES groups , respectively ( P = 0.08 ) . Both postoperative ( 0–24 h ) and total perioperative erythrocyte transfusion requirements did not differ significantly between the groups ( P = 0.32 and 0.14 , respectively ) . Conclusion The prophylactic administration of a therapeutic dose ( 15 ml/kg ) of autologous FFP after CPB failed to reduce blood loss and transfusion requirements in patients undergoing uncomplicated , elective , primary coronary artery bypass surgery Fresh frozen plasma ( FFP ) has been 
    Output:
    
RESULTS Based on evidence ranging primarily from moderate to very low in quality , the panel developed the following guidelines : 1 ) The panel suggested that plasma be transfused to patients requiring massive transfusion .
6 ) The panel suggested against plasma transfusion for other selected groups of patients .