Apatient with a history of warfarin (coumadin) therapy for vte is admitted with multitrauma and receives five units of packed rbcs. which factors might indicate the patient should receive fresh frozen plasma (ffp) also?

Since the patient is on warfarin therapy, bleeding will be severe in cases of trauma. In a previously normal patient with no anticoagulant or antiplatelet therapy, the patient will stabilize after tranfusion of said amounts of packed RBC. Although in a patient on warfarin therapy, there might be hidden active bleeding (commonly from pelvic fractures) and transfusion by packed RBC will not suffice. The patient should receive antidote for warfarin which is vitamin K but if the patient is still unstable and is not responding, then fresh frozen plasma or FFP should be given. FFP contains all coagulation factors except factor XIII which will reverse the effects of warfarin.

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