It is clear that our erroneous dependence on the INR for the routine screening and treatment of coagulopathy and bleeding is harming patients and wasting limited resources. Use of the PT and INR should be to answer their narrow spectrum of appropriate clinical questions. We are also compounding the issue by misinterpreting these tests in the setting of ESLD, whose “rebalanced” hemostasis is best reflected only in the newer clot-formation assays. It is time to leave the old dogma behind and look at coagulation through a better lens.
Explore This Issue
ACEP Now: Vol 35 – No 10 – October 2016References
- ACEP DRAFT quality measures for public comment. Measure #3: coagulation studies in adult patients presenting with chest pain with no coagulopathy or bleeding. ACEP website. Accessed Sept. 2, 2016.
- Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147-156.
- Massicotte L, Denault AY, Beaulieu D, et al. Transfusion rate for 500 consecutive liver transplantations: experience of one liver transplantation center. Transplantation. 2012;93(12):1276-1281.
- Durila M, Lukas P, Astraverkhava M, et al. Tracheostomy in intensive care unit patients can be performed without bleeding complications in case of normal thromboelastometry results (EXTEM CT) despite increased PT-INR: a prospective pilot study. BMC Anesthesiol. 2015;15:89. De Pietri L, Bianchini M, Montalti R, et al.
- Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: a randomized, controlled trial. Hepatology. 2016;63(2):566-573.
- Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11-21.
Pages: 1 2 3 | Single Page
No Responses to “Improper Use of International Normalized Ratio Test Can Lead to Misuse of Resources, Patient Harm”