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The International Normalized Ratio overestimates coagulopathy in stable trauma and surgical patients
- Source :
- Journal of Trauma and Acute Care Surgery. 75:947-953
- Publication Year :
- 2013
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2013.
-
Abstract
- The international normalized ratio (INR) was developed to assess adequacy of Coumadin dosing. Its use has been generalized to guide fresh frozen plasma (FFP) therapy in stable patients. Thrombelastography (TEG) is a whole-blood assay measuring the viscoelastic properties of the clot in near real time. This study hypothesized that INR does not reflect coagulopathy and should not be used to guide FFP therapy in stable trauma and surgical patients.Prospective observational data were collected from stable trauma and surgical patients (n = 106) who received FFP transfusions. Pretransfusion and posttransfusion blood samples were obtained to assess complete blood count, standard coagulation parameters (INR, partial thromboplastin time, fibrinogen and D-dimer), soluble clotting factors (II, V, VII, VIII, IX, X, XI, XII, proteins C and S) and TEG. Data were analyzed using a Mann-Whitney U-test. Significance was defined as p0.05.A total of 262 U of FFP were transfused, with 78% of 106 patients receiving two or more units. Despite a reduction in INR, median TEG values remained within normal limits, while clotting factor levels retained adequate function to produce normal clotting before and following FFP transfusion.The use of FFP in this population did not affect coagulation status in a clinically relevant manner based on TEG values and coagulation factor function. INR is not a predictor of coagulopathy and should not be used to guide coagulation factor replacement in stable trauma and surgical patients.Diagnostic study, level III.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
Critical Care and Intensive Care Medicine
Young Adult
Postoperative Complications
Coagulopathy
Humans
Medicine
International Normalized Ratio
Prospective Studies
Dosing
Blood Coagulation
Aged
Aged, 80 and over
business.industry
Blood Coagulation Disorders
Middle Aged
medicine.disease
Thrombelastography
Surgery
Coagulation
Wounds and Injuries
Female
Fresh frozen plasma
business
Follow-Up Studies
Surgical patients
Subjects
Details
- ISSN :
- 21630755
- Volume :
- 75
- Database :
- OpenAIRE
- Journal :
- Journal of Trauma and Acute Care Surgery
- Accession number :
- edsair.doi.dedup.....67f243d6615189944864cf63005dd2ab