Correction of INR and/or PLT for Procedures
VBMC TRAUMA CARE SERVICES GUIDELINE
Correction of INR and/or PLT for Procedures
PT, PTT and platelet counts as
predictors of bleeding lack specificity. Prophylactic treatment of patients
undergoing minimally invasive procedures with blood products targeted at
specific PT, PTT, INR and PLT counts is probably not indicated in many cases.
If any of these patients bleed excessively it is often not from moderate
coagulopathy (as defined by these 3 tests), but for other reasons.
Rather, platelets and FFP are best used to treat a significant bleed
and not to prevent one. To mention just a few - The University of Kansas
Medical Center, Massachusetts General Hospital, and 25 hospitals in the
Province of Ontario, Canada have adopted performing such minimally
invasive procedures with an INR of 2.0 and a platelet count of 30, 000.
Implementation of these new transfusion triggers can decrease length of stays for our patients because of decreased transfusion transmitted immune modulation (less pneumonia and less UTIs), decrease procedural delays from the requirement to transfuse platelets and FFP and decrease transfusion reactions.
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Approved Practice Guidelines for Minimally Invasive Bedside Procedures
for Non-Emergent Cases |
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1.5 INR,
50,000 Platelets |
1.8 INR,
40K Plt |
2.0 INR,
30,000 Platelets |
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Transbronchial, debridement, tumor de-bulking |
Liver Biopsy |
PICC line |
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GI Polypectomy and biopsies |
Central Line -ultrasound guided IJ access |
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Central Line – Subclavian, Femoral |
GI Endoscopy Screening without biopsy |
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Renal Biopsy |
Bronchoscopy brush, wash, thin needle, EUB |
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LP |
Thoracentesis |
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Paracentesis |
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Note: “While many practice guidelines recommend INR 1.5 and platelet count
50,000, it is recognized that in some patients it may not be achievable or
practical to bring the INR to 1.5 or platelet count to 50,000. There is
evidence that these minimally invasive bedside procedures can be and are done
safely at higher INRs and lower platelet counts. In these patients the
clinical diagnostic need for the procedure may outweigh risks associated with
INR or platelet count values.”