Key result
Among patients with an INR >9, bleeding occurred in 67% of unanticoagulated patients, 35% of inpatients on warfarin, and 11% of outpatients on warfarin; plasma infusion rapidly reduced INR.
Why the study?
Does plasma infusion compared to withholding warfarin or vitamin K treatment improve INR reduction in patients with INR higher than 9?
Observational (n=162)
Does plasma infusion compared to withholding warfarin or vitamin K treatment improve INR reduction in patients with INR higher than 9?
In patients with an INR >9, plasma infusion effectively and rapidly reduces INR within 24 hours, whereas withholding warfarin or administering vitamin K is often ineffective, particularly in hospitalized patients.
Variable bleeding risk by anticoagulation status in INR>9 patients advises caution; leaves open plasma's clinical benefit versus alternatives.
An international normalized ratio (INR) higher than 9 is associated with a high risk of bleeding, yet most studies have focused on outpatients with lower INR. We retrospectively analyzed diagnosis, bleeding, treatment, and mortality in 162 patients with INR higher than 9, including inpatients and outpatients with and without warfarin treatment. Patients without anticoagulant treatment with INR higher than 9 had a poor prognosis, 67% experienced bleeding and 74% died. Among outpatients receiving warfarin with INR higher than 9, 11% had bleeding, but none died. Among inpatients receiving warfarin, 35% had bleeding and 17% died. Factors associated with bleeding were older age, renal failure, and alcohol use. Withholding warfarin or giving vitamin K treatment was ineffective at reducing the INR within 24 hours, whereas plasma infusion immediately dropped the INR to 2.4 ± 0.9. Because of underlying disease, comorbidities, and medications, hospitalized patients with INR higher than 9 may not respond quickly to withholding warfarin or vitamin K treatment, and plasma infusion may be needed to reduce INR and the risk of bleeding within 24 hours.
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Pagano et al. (2012) conducted an observational in INR higher than 9 (n=162). INR higher than 9 was evaluated on Bleeding and mortality. Among patients with an INR >9, bleeding occurred in 67% of unanticoagulated patients, 35% of inpatients on warfarin, and 11% of outpatients on warfarin; plasma infusion rapidly reduced INR.
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