Elevated International Normalized Ratio (INR) is Associated With an Increased Risk of Intraventricular Hemorrhage in Extremely Preterm Infants

Williams, Alessandra Glover; Odd, David; Bates, Sarah; Russell, G.B.; Heep, Axel

doi:10.1097/mph.0000000000001509

Cited by 5 publications

(1 citation statement)

References 35 publications

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“…The international normalized ratio (INR) refers to the ratio of prothrombin time to the normal prothrombin time 30 and is regarded as an ideal method for judging the anticoagulation effect 31 . It overcomes the variability among different laboratories by thromboplastin sensitivity 32 . Among the patients using warfarin, the INR was kept between the therapeutic range of 2.0 and 3.0 33 .…”

Section: Introductionmentioning

confidence: 99%

Effect of an Elevated Preoperative International Normalized Ratio on Transfusion and Complications in Primary Total Hip Arthroplasty with the Enhanced Recovery after Surgery Protocol

Peng

Zeng

et al. 2021

Orthopaedic Surgery

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Objective: To verify whether an elevated preoperative international normalized ratio (INR) increases transfusion and complications independently in primary total hip arthroplasty (THA) with the management of an enhanced recovery after surgery (EARS) protocol. Methods:We retrospectively reviewed the database of adults who underwent primary THA between 2014 and 2018 by the same surgeon. A total of 552 patients were assigned into three groups by preoperative INR class: INR ≤ 0.9, 0.9 < INR < 1.0, and INR ≥ 1.0. We regarded transfusion within 90 days during the same hospitalization as the primary outcome. We also included perioperative blood loss, maximum Hb drop, postoperative anaemia requiring medicine, and length of hospital stay (LOS) during the same hospitalization in the study. Complications and reoperation at 90 days and mortality at 90 days and 12 months were also included in the study. Univariable analyses were utilized to compare baselines and outcomes among the three groups. Multivariate logistic regressions were used to adjust for differences at baseline among the groups.Results: All patients had an INR < 1.5 preoperatively and were managed with the ERAS protocol. Among them, 93 (16.8%) patients had INR ≤ 0.9, 268 (48.6%) patients had 0.9 < INR < 1.0, and 191 (34.6%) patients had INR ≥ 1.0. In the univariable analyses, as the INR increased, the transfusion rates increased from 1.08% for INR ≤ 0.9, to 1.12% for 0.9 < INR < 1.0 and to 5.76% for INR ≥ 1.0 (P < 0.05). The overall complication rate increased from 10.8% for INR ≤ 0.9, to 16.4% for 0.9 < INR < 1.0, and to 22.5% for INR ≥ 1.0 (P < 0.05). The length of stay (LOS) in the INR ≥ 1.0 group was 5.7 AE 2.2 days, which was significantly longer than that in the INR ≤ 0.9 group (4.7 AE 1.6 days, P = 0.000) and 0.9 < INR < 1.0 group (5.1 AE 2.0 days, P = 0.007). No statistical significance was detected among the groups regarding blood loss, maximum Hb drop, or the incidence of postoperative anaemia that required medicine. There was no significant difference in reoperation or mortality among the groups. When controlling for demographic and comorbidity characteristics, there was no statistically significant difference in the odds of transfusion during the same hospitalization or overall complications at 90 days among the groups (P > 0.05). Conclusions: Elevated preoperative INR cannot increase transfusion or complication rates independently in primaryTHA with the management of the ERAS protocol. With the improvement in the ERAS protocol and the use of tranexamic acid (TXA), an INR < 1.5 is still a conventional safe threshold for THA surgery.

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Section: Introductionmentioning

confidence: 99%

Effect of an Elevated Preoperative International Normalized Ratio on Transfusion and Complications in Primary Total Hip Arthroplasty with the Enhanced Recovery after Surgery Protocol

Peng

Zeng

et al. 2021

Orthopaedic Surgery

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Coagulation profiles and percentiles in neonates with hypoxic‐ischemic encephalopathy undergoing therapeutic hypothermia: A step toward more accurate transfusion thresholds

De Rose,

Maddaloni,

Ronci

et al. 2024

Pediatric Blood & Cancer

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BackgroundIn the literature, there are no studies about the transfusion threshold for neonates with hypoxic‐ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). In order to facilitate accurate interpretation of coagulation results in these neonates, we aimed to generate specific reference intervals in this specific population.MethodsThis retrospective study included all HIE neonates admitted from 2014 to 2022 to undergo TH. All infants during TH underwent blood exams, including the coagulation profile. Our primary outcome was to assess the estimates of the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for each parameter on admission (before transfusion). By the receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) and the best cut‐off point were used to evaluate the ability of the prothrombin time expressed as international normalized ratio (PT‐INR) to predict the risk of any bleeding.ResultsA total of 143 infants were included in this study. On admission, the median fibrinogen value was 205 mg/dL, prothrombin time 18.6 seconds, PT‐INR 1.50, activated partial thromboplastin time 38.3 seconds, thrombin time 18.6 seconds, antithrombin 57.0%. The optimal cut‐off of PT‐INR in predicting the risk of any bleeding was greater than 1.84 (AUC .623, p = .024).ConclusionFor the first time, we proposed the percentiles of coagulation parameters in our cohort of neonates with HIE. Furthermore, we found that a PT‐INR greater than 1.84 can significantly predict the risk of any bleeding. Further studies are needed to determine if a restrictive versus a liberal transfusion approach can be equally safer for these high‐risk infants.

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Preoperative Elevated International Normalized Ratio Cannot Increase Transfusion or Complication in Primary Total Hip Arthroplasty: A Retrospective Study of 552 Cases

Peng¹,

Zeng²,

Zeng³

et al. 2020

Preprint

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Background: Verify if the elevated preoperative International Normalized Ratio (INR) can increase transfusion and complication rate in primary total hip arthroplasty.Methods: We retrospectively reviewed the database of adults who underwent primary total hip arthroplasty between 2014 to 2018 by the same surgeon. 552 cases were assigned into 3 groups by preoperative INR class: INR≤0.9, 0.9＜INR＜1.0, and INR≥1.0 eventually. We regarded the transfusion rate as the primary outcome. We also included perioperative blood loss, maximum Hb-drop, postoperative anemia needs medicine, length of stay (LOS), re-operation, the complication rate in 90 days and mortality as the secondary outcomes. Univariable analyses were utilized to compare baselines and outcomes between groups. Binary Logistic Regression was used to adjust differences of baselines among groups.Results: All the cases had an INR＜1.5. Among all the cases, 93(16.8%) had INR≤0.9, 268 (48.6%) had 0.9＜INR＜1.0, and 191 (34.6%) had INR≥1.0, respectively. In the univariable analyses, with the INR elevated, The transfusion rates increased from 1.08% for INR≤0.9, 1.12% for 0.9＜INR＜1.0 to 5.76% for INR≥1.0 (p＜0.05). The overall complication rate increased from 10.8% for INR≤0.9, 16.4% for 0.9＜INR＜1.0 to 22.5% for INR≥1.0 (p＜0.05). When controlling for the demographics and comorbidities characteristics, there was no statistically significant difference when evaluating the odds of transfusion nor overall complication rate between the groups (p＞0.05).Conclusions: The transfusion and complication rate cannot increase along with the INR elevated in primary THA. With the improvement of arthroplasty protocol and use of tranexamic acid, the INR＜1.5 was still a conventional safe threshold.

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Elevated International Normalized Ratio (INR) is Associated With an Increased Risk of Intraventricular Hemorrhage in Extremely Preterm Infants

Cited by 5 publications

References 35 publications

Effect of an Elevated Preoperative International Normalized Ratio on Transfusion and Complications in Primary Total Hip Arthroplasty with the Enhanced Recovery after Surgery Protocol

Effect of an Elevated Preoperative International Normalized Ratio on Transfusion and Complications in Primary Total Hip Arthroplasty with the Enhanced Recovery after Surgery Protocol

Coagulation profiles and percentiles in neonates with hypoxic‐ischemic encephalopathy undergoing therapeutic hypothermia: A step toward more accurate transfusion thresholds

Preoperative Elevated International Normalized Ratio Cannot Increase Transfusion or Complication in Primary Total Hip Arthroplasty: A Retrospective Study of 552 Cases

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