***TASK*** the task is to summarize 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 PURPOSE To determine whether prothrombin time ( PT ) , partial thromboplastin time ( PTT ) , and platelet count are useful predictors of postangiographic hematoma . MATERIAL S AND METHODS The authors prospect ively studied 1,000 consecutive patients who underwent femoral arterial puncture for a diagnostic or therapeutic vascular procedure . Demographic and procedural variables were recorded , including patient age and sex , history of medications and bleeding , procedure type and length , catheter size , and experience level of radiologist applying compression for hemostasis . RESULTS Abnormal results of coagulation tests were not correlated with an increased occurrence of hemorrhagic complications , but bleeding complications did occur more often in patients with thrombocytopenia . Hematomas occurred in 8.1 % ( 10 of 123 ) of patients with any abnormal coagulation test results and 9.7 % ( 85 of 877 ) of patients with normal test results . A platelet count of less than 100 X 10(9)/L was correlated with a higher occurrence of hematoma ( P = .002 ) . CONCLUSION Abnormal PT and PTTs do not correlate with an increased risk of postangiographic hematoma , but a low platelet count is associated with more bleeding complications 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 : This prospect i ve r and omized controlled trial compared 1:1 vs 4:1 packed red blood cell with fresh frozen plasma ( PRBC/FFP ) transfusion strategy on outcomes in children with > 20 % TBSA burns . Children with > 20 % TBSA burns were r and omized to a 1:1 or 4:1 PRBC/FFP transfusion ratio during burn excision . Parameters measured included demographics , TBSA burn , and Pediatric Risk of Mortality scores . Laboratory values recorded preoperatively , 1 hour , 12 hours , 24 hours , and 1 week postoperatively included prothrombin time , partial thromboplastin time ( PTT ) , international normalized ratio , fibrinogen , protein C , and antithrombin C ( AIII ) . Total number of blood products transfused intraoperatively and during hospitalization was recorded . Forty-five children were enrolled , 22 in the 1:1 and 23 in the 4:1 group . Groups were similar in age , TBSA , and Pediatric Risk of Mortality score .  Preoperative fibrinogen , AIII , protein C , hemoglobin , PTT , international normalized ratio , and platelets were similar . In the first two excisions , the 1:1 group received significantly more FFP per patient . Volume of PRBC and overall product transfused did not differ between groups . At 1 hour postoperatively , prothrombin time and PTT were lower and protein C and AIII were higher in the 1:1 group . The 4:1 group was more significantly acidotic 1 hour postexcision . A 1:1 PRBC/FFP transfusion strategy , compared with a 4:1 strategy , decreased postoperative markers of coagulopathy and acidosis immediately after surgery . The strategy did not change the total volume of blood product transfused . This interim analysis was not powered to detect differences in wound healing and length of stay Background Liver failure patients have traditionally been empirically transfused prior to invasive procedures . Blood transfusion is associated with immunologic and nonimmunologic reactions , increased risk of adverse outcomes and high costs . Scientific evidence supporting empirical transfusion is lacking , and the best approach for blood transfusion prior to invasive procedures in cirrhotic patients has not been established so far . The aim of this study is to compare three transfusion strategies ( routine coagulation test-guided – ordinary or restrictive , or thromboelastometry-guided ) prior to central venous catheterization in critically ill patients with cirrhosis . Methods / design Design and setting : a double-blinded , parallel-group , single-center , r and omized controlled clinical trial in a tertiary private hospital in São Paulo , Brazil . Inclusion criteria : adults ( aged 18 years or older ) admitted to the intensive care unit with cirrhosis and an indication for central venous line insertion . Patients will be r and omly assigned to three groups for blood transfusion strategy prior to central venous catheterization : st and ard coagulation tests-based , thromboelastometry-based , or restrictive . The primary efficacy endpoint will be the proportion of patients transfused with any blood product prior to central venous catheterization . The primary safety endpoint will be the incidence of major bleeding . Secondary endpoints will be the proportion of transfusion of fresh frozen plasma , platelets and cryoprecipitate ; infused volume of blood products ; hemoglobin and hematocrit before and after the procedure ; intensive care unit and hospital length of stay ; 28-day and hospital mortality ; incidence of minor bleeding ; transfusion-related adverse reactions ; and cost analysis . Discussion This study will evaluate three strategies to guide blood transfusion prior to central venous line placement in severely ill patients with cirrhosis . We hypothesized that thromboelastometry-based and /or restrictive protocol s are safe and would significantly reduce transfusion of blood products in this population , leading to a reduction in costs and transfusion-related adverse reactions . In this manner , this trial will add evidence in favor of reducing empirical transfusion in severely ill patients with coagulopathy . Trial registration Clinical Trials.gov , identifier : NCT02311985 . Retrospectively registered on 3 December 2014 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 BACKGROUND Prophylactic use of fresh-frozen plasma ( FFP ) is common practice in patients with a coagulopath 
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AUTHORS ' CONCLUSIONS Review findings show uncertainty for the utility and safety of prophylactic FFP use .
Therefore , from the limited RCT evidence , we can neither support nor oppose the use of prophylactic FFP in clinical practice