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INR Is Not an Accurate Predictor of Coagulopathy in Trauma Patients

Summary and Comment |
January 24, 2014

INR Is Not an Accurate Predictor of Coagulopathy in Trauma Patients

  1. Richard D. Zane, MD, FAAEM

Thromboelastography is a better predictor and is more clinically relevant.

  1. Richard D. Zane, MD, FAAEM

The international normalized ratio (INR) is measured routinely in trauma patients and is commonly used as a measurement of coagulopathy and a guide for the administration of fresh frozen plasma (FFP). Thromboelastography is a point-of-care coagulation assay that uses the time-dependent viscoelastic properties of whole blood to provide an assessment of clotting ability; it is considered more clinically relevant than INR. In this prospective observational study of 106 adult hemodynamically stable surgical and trauma patients receiving FFP, researchers measured thromboelastography values, clotting factor levels, and INRs before and after FFP infusion. FFP was administered based on the attending surgeon's discretion.

Administration of FFP significantly decreased the median INR (from 1.87 to 1.53), but did not change thromboelastography values or clotting factor levels, all of which remained normal.

Comment

INR is not a clinically relevant predictor of coagulopathy in trauma patients and should not be used to assess coagulation status or guide administration of fresh frozen plasma. Clinical assessment of bleeding as well as transfusion requirement should continue to guide FFP administration. As thromboelastography becomes more available, it may have a role in guiding blood product use in the acute management of hemorrhage.

  • Disclosures for Richard D. Zane, MD, FAAEM at time of publication Editorial boards Pocket Emergency Medicine

Citation(s):

Reader Comments (3)

James L. Baker, M.D., M.P.H. Physician, Emergency Medicine, Academics/Clinical Practice

Having managed Level I emergency departments for twenty years, this kind of article is dangerous - it may lead clinicians to think "The INR doesn't matter" and forget that thromboelastography is at present only a phantom option. And note the article states "...in STABLE trauma patients..." -- so why would it even matter?

Matteo Giorgi Pierfrancesch Physician, Internal Medicine, Piacenza, Italy

thromboelastography allows to diagnose and correct the coagulopathy in a tailored way.
INR should be used only for patients on warfarin therapy

Dr.Sajjad Zaidi Physician, Anesthesiology, Freelancer in private hospitals

Very interesting abstract.

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