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Typically, a reactive transfusion strategy is used to treat coagulopathy whereby fresh frozen plasma (<jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content>) is given only after clinical manifestation of clotting abnormality. This prospective, randomized clinical trial was designed to test the hypothesis that prophylactic <jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content> during craniofacial surgery reduces blood loss and blood transfusion requirements compared to a reactive <jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content> transfusion strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty\u2010one patients less than 2\u00a0years of age requiring primary repair of craniosynostosis were randomized to receive <jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content> using either a prophylactic or reactive strategy. Laboratory values were measured at four standardized time points. The volume of blood products transfused, length of stay in the pediatric intensive care unit (<jats:styled-content style=\"fixed-case\">PICU<\/jats:styled-content>), hospital length of stay, and number of donor exposures were recorded for each patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prophylactic <jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content> group received a significantly greater average volume of <jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content> compared to the reactive group (29.7\u00a0ml\u00b7kg<jats:sup>\u22121<\/jats:sup> vs 16.1\u00a0ml\u00b7kg<jats:sup>\u22121<\/jats:sup>; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), which was associated with improvement in coagulation values at multiple time points. However, there was no difference in blood transfusion requirements or blood loss between the two groups. The two transfusion strategies resulted in similar median donor exposures. There was no difference in <jats:styled-content style=\"fixed-case\">PICU<\/jats:styled-content> or hospital length of stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A reactive <jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content> transfusion strategy required less plasma transfusion and was associated with similar rates of blood loss and <jats:styled-content style=\"fixed-case\">PRBC<\/jats:styled-content> transfusion as prophylactic <jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content> despite improvement in coagulation values in the prophylactic <jats:styled-content style=\"fixed-case\">FFP<\/jats:styled-content> group.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.12571","type":"journal-article","created":{"date-parts":[[2014,12,19]],"date-time":"2014-12-19T06:55:12Z","timestamp":1418972112000},"page":"279-287","source":"Crossref","is-referenced-by-count":17,"title":["Prophylactic versus reactive transfusion of thawed plasma in patients undergoing surgical repair of craniosynostosis: a randomized clinical trial"],"prefix":"10.1111","volume":"25","author":[{"given":"Benjamin J.","family":"Pieters","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Children's Mercy Hospital and Clinics Kansas City MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Conley","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Children's Mercy Hospital and Clinics Kansas City MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Weiford","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Children's Mercy Hospital and Clinics Kansas City MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Pathology Children's Mercy Hospital and Clinics Kansas City MO 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