Brief Reports THE EFFECT OF FRESH FROZEN PLASMA TRANSFUSION ON INTERNATIONAL NORMALIZED RATIO IN EMERGENCY DEPARTMENT PATIENTS Savas ¸ Sezik, MD, Ersin Aksay, MD, and Turgay Yılmaz Kılıc ¸, MD Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir, Turkey Reprint Address: Ersin Aksay, MD, Department of Emergency Medicine, Tepecik Training and Research Hospital, Gaziler Caddesi, Yenisehir, Izmir 35120, Turkey , Abstract—Background: There are few studies research- ing the effect of fresh frozen plasma (FFP) transfusion on international normalized ratio (INR) in patients with coagu- lation abnormality. Objective: This study’s aim was to deter- mine the effect of FFP transfusion on INR as calculated pretransfusion. In addition, patients were grouped according to pretransfusion INR to determine the improvement in INR per unit of FFP. Methods: Adult patients who had been admitted to our Emergency Department (ED) with coagula- tion abnormality and received an FFP transfusion, and had pre- and posttransfusion coagulation tests performed, were included in the study. Patients were categorized into five groups according to their pretransfusion INR levels. Improvement in INR per unit of FFP-transfused values (D INR 1 unit FFP ) was determined for each group. Results: Eighty-seven patients were entered into the study, and were administered a total of 199 units of FFP. D INR 1 unit FFP value was 0.03 ± 0.13 for patients whose pretransfusion INR level was under 2; 0.77 ± 0.47 for those between 2 and 5; 2.14 ± 0.63 for those between 5 and 9; 3.34 ± 0.89 for those between 9 and 12; and 4.63 ± 1.99 for those over 12. Avery strong positive correlation was found between pretransfusion INR and D INR 1 unit FFP (p < 0.001, r = 0.957). Conclusion: A significant improvement in INR was observed in patients with higher pretransfusion INR. While determining FFP dose for patients admitted to the ED due to coagulation defect, pretransfusion INR value should be taken into account. Ó 2014 Elsevier Inc. , Keywords—international normalized ratio; INR; fresh frozen plasma; transfusion; blood transfusion; emergency department INTRODUCTION The use of fresh frozen plasma (FFP) transfusion is grad- ually increasing worldwide (1–4). FFP is widely used in patients admitted to emergency departments (EDs) with coagulation abnormality. However, there are no widely accepted standardized doses of FFP to be administered to patients according to the severity of their coagulation abnormality. The number of studies investigating the improvement in international normalized ratio (INR) achieved per unit of FFP transfused is limited (5,6). In our study, we investigated how much improvement was achieved, per unit of FFP that was transfused, over pretransfusion INR values. METHODS In this cross-sectional retrospective study, we conducted a review of the records of patients, presenting over a period of 34 months (January 2010–October 2012), who were older than 14 years of age, admitted to our ED, transfused with FFP, and who also had pre- and posttransfusion coagulation tests. The study was carried out in a tertiary ED that serves approximately 200,000 patients annually. Patients who received FFP transfusions were identified from the hospital automated record system, and their re- cords were scanned. The first and third authors of the study abstracted the data. Patient charts, nurse observation charts, and the hospital database were reviewed for data RECEIVED: 28 September 2013; FINAL SUBMISSION RECEIVED: 11 February 2014; ACCEPTED: 28 April 2014 596 The Journal of Emergency Medicine, Vol. 47, No. 5, pp. 596–600, 2014 Copyright Ó 2014 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2014.04.042