 In summary, FP is commonly transfused prior to invasive procedures in patients with an elevated INR. Remarkably, there is no evidence that transfusing FP reduces bleeding complications when transfused prophylactically. Observational data suggests that an elevated INR does not increase risk of bleeding from invasive procedures. However, there is no randomized clinical trial data to support not transfusing FP. This lack of evidence combined with fear of causing bleeding during an invasive procedure and an under-appreciation of the potential harms associated with blood transfusions contributes to continued practice of transfusing FP prior to invasive procedures. Given that mild to moderately increased coagulation tests have not been associated with increased bleeding following invasive procedures and the FP transfusion are known to only partially correct abnormal coagulation tests, the prophylactic use of FP may be exposing patients to potentially life-threatening adverse reactions without providing any benefit. Previous randomized controlled trials of FP transfusions prior to invasive procedures have failed to enroll sufficient patients, but they had important limitations in their design that affected their ability to recruit patients. 