title: A high fresh frozen plasma: packed red blood cell transfusion ratio decreases mortality in all massively transfused trauma patients regardless of admission international normalized ratio.
abstract: BACKGROUND
  Coagulopathy is present in 25% to 38% of trauma patients on arrival to the hospital, and these patients are four times more likely to die than trauma patients without coagulopathy. Recently, a high ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBCs) has been shown to decrease mortality in massively transfused trauma patients. Therefore, we hypothesized that patients with elevated International Normalized Ratio (INR) on arrival to the hospital may benefit more from transfusion with a high ratio of FFP:PRBC than those with a lower INR.
  
  
  METHODS
  Retrospective multicenter cohort study of 437 massively transfused trauma patients was conducted to determine whether the effect of the ratio of FFP:PRBC on death at 24 hours is modified by a patient's admission INR on arrival to the hospital. Contingency tables and logistic regression were used.
  
  
  RESULTS
  Trauma patients who arrived to the hospital with an elevated INR had a greater risk of death than those with a lower INR. However, as the ratio of FFP:PRBC transfused increased, mortality decreased similarly between the INR quartiles.
  
  
  CONCLUSIONS
  The mortality benefit from a high FFP:PRBC ratio is similar for all massively transfused trauma patients. This is contrary to the current belief that only coagulopathic trauma patients benefit from a high FFP:PRBC ratio. Furthermore, it is unnecessary to determine whether INR is elevated before transfusing a high FFP:PRBC ratio. Future studies are needed to determine the mechanism by which a high FFP:PRBC ratio decreases mortality in all massively transfused trauma patients.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, California 94143-0470, USA. lisa.brown@ucsfmedctr.org
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mesh_terms: D000328:Adult; D016913:Blood Component Transfusion; D004906:Erythrocyte Count; D005260:Female; D006470:Hemorrhage / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010949:Plasma; D012189:Retrospective Studies; D015996:Survival Rate; D014947:Wounds and Injuries / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D055815:Young Adult