Normalisation Of The International Normalised Ratio Prior To Interventional Procedure: Is It Necessary?
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Date
2017
Authors
Mohamad Mahyedin, Mohd Tarmizi
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Background: The fresh frozen plasma (FFP) is frequently prescribed by the clinicians either for therapeutic or prophylactic purpose. Prophylactic FFP transfusion in coagulopathic patient is given to prevent any bleeding complications during invasive procedures. The international normalised ratio (INR) value of 1.50 and above is frequently reported to be a transfusion trigger for FFP prior to interventional procedure. This study aims to evaluate the efficacy of FFP transfusion in normalising the INR prior to interventional procedures. On top of that, it is also to determine the post-transfusion outcomes (INR difference, bleeding episodes and adverse transfusion reactions). Methods: A prospective cross-sectional study involved 81 patients who received prophylactic FFP transfusion prior to interventional procedures over a period of three months (December 2016 until February 2017). The study was conducted at both Hospital Kuala Lumpur and Pusat Darah Negara. Study subjects with abnormal coagulation with abnormal coagulation with abnormal coagulation with abnormal coagulation with abnormal coagulation with abnormal coagulation with abnormal coagulation with abnormal coagulation with abnormal coagulation laboratory value ( laboratory value (laboratory value ( laboratory value (laboratory value (laboratory value (laboratory value (laboratory value ( laboratory value (pretransfusion pretransfusion pretransfusion pretransfusion INR above 1.50)INR above 1.50) INR above 1.50)INR above 1.50) INR above 1.50)INR above 1.50)INR above 1.50) INR above 1.50) were selected by purposive (non-probability) sampling. Data retrieved from patient’s medical record and were filled in the research proforma. All demographic and clinical data in regards to the outcome of FFP transfusion were captured.
Results: The proportion of patients achieved posttransfusion INR below 1.51 was 30.30% (n=27) with one patient normalised to normal value (INR < 1.20). Only two patients developed bleeding episodes post interventional procedure (one with major bleeding episode and one with minor bleeding episode). The percentage of adverse transfusion reactions was low with 2.50%. The majority of patients underwent the interventional procedures with posttransfusion INR values of above 1.50 (n=52) without experiencing any bleeding episodes. Overall, FFP transfusion resulted in significant median difference of INR from 1.89 (IQR, 0.53) to 1.60 (IQR, 0.25); p < 0.001. The greater median INR difference was observed in group with pretransfusion INR above 2.00 and in group who received FFP doses between 10.00 to 20.00 ml kg-1 (p < 0.001). The INR difference showed the significant, positive correlation with pretransfusion INR values (rs = 0.83, p < 0.001) and FFP doses (rs = 0.72, p < 0.001).
Conclusions: The interventional procedures were safely carried out despite abnormal posttransfusion INR (uncorrected INR). The prophylactic FFP transfusions could be avoided in patients with mild coagulopathy (INR 1.50 - 2.00) prior interventional procedures. The risk of bleeding could be minimised by clinicians with the good techniques.
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Keywords
Prophylactic FFP transfusion, interventional procedures , international normalised ratio, FFP doses, Coagulopathy