Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: Effect on plasma transfusion therapy: Clinical article

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Abstract

Object. Neurosurgical patients often have mildly prolonged prothrombin time (PT) or international normalized ratio (INR). In the absence of liver disease this mild prolongation appears to be due to the use of very sensitive PT reagents. Therefore, the authors performed relevant coagulation factor assays to assess coagulopathy in such patients. They also compared plasma transfusion practices in their hospital before and after the study. Methods. The authors tested 30 plasma specimens from 25 patients with an INR of 1.3-1.7 for coagulation factors II, VII, and VIII. They also evaluated plasma orders during the 5-month study period and compared them with similar poststudy periods following changes in plasma transfusion guidelines based on the study results. Results. At the time of plasma orders the median INR was 1.35 (range 1.3-1.7, normal reference range 0.9-1.2) with a corresponding median PT of 13.6 seconds (range 12.8-17.6 seconds). All partial thromboplastin times were normal (median 29.0 seconds, range 19.3-33.7 seconds). The median factor VII level was 57% (range 25%-124%), whereas the hemostatic levels recommended for major surgery are 15%-25%. Factors II and VIII levels were also within the hemostatic range (median 72% and 118%, respectively). Based on these scientific data, plasma transfusion guidelines were modified and resulted in a 75%-85% reduction in plasma orders for mildly prolonged INR over the next 2 years. Conclusions. Neurosurgical patients with a mild prolongation of INR (up to 1.7) have hemostatically normal levels of important coagulation factors, and the authors recommend that plasma not be transfused to simply correct this abnormal laboratory value.

Original languageEnglish (US)
Pages (from-to)3-7
Number of pages5
JournalJournal of Neurosurgery
Volume114
Issue number1
DOIs
StatePublished - Jan 2011

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Blood Coagulation Factors
Prothrombin Time
International Normalized Ratio
Factor VII
Factor VIII
Prothrombin
Hemostatics
Therapeutics
Reference Values
Guidelines
Partial Thromboplastin Time
Liver Diseases

Keywords

  • Coagulation factor
  • International normalized ratio
  • Plasma
  • Prothrombin time
  • Transfusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

@article{8ff4fd6c0b704007a2bbf7a5be5414a1,
title = "Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: Effect on plasma transfusion therapy: Clinical article",
abstract = "Object. Neurosurgical patients often have mildly prolonged prothrombin time (PT) or international normalized ratio (INR). In the absence of liver disease this mild prolongation appears to be due to the use of very sensitive PT reagents. Therefore, the authors performed relevant coagulation factor assays to assess coagulopathy in such patients. They also compared plasma transfusion practices in their hospital before and after the study. Methods. The authors tested 30 plasma specimens from 25 patients with an INR of 1.3-1.7 for coagulation factors II, VII, and VIII. They also evaluated plasma orders during the 5-month study period and compared them with similar poststudy periods following changes in plasma transfusion guidelines based on the study results. Results. At the time of plasma orders the median INR was 1.35 (range 1.3-1.7, normal reference range 0.9-1.2) with a corresponding median PT of 13.6 seconds (range 12.8-17.6 seconds). All partial thromboplastin times were normal (median 29.0 seconds, range 19.3-33.7 seconds). The median factor VII level was 57{\%} (range 25{\%}-124{\%}), whereas the hemostatic levels recommended for major surgery are 15{\%}-25{\%}. Factors II and VIII levels were also within the hemostatic range (median 72{\%} and 118{\%}, respectively). Based on these scientific data, plasma transfusion guidelines were modified and resulted in a 75{\%}-85{\%} reduction in plasma orders for mildly prolonged INR over the next 2 years. Conclusions. Neurosurgical patients with a mild prolongation of INR (up to 1.7) have hemostatically normal levels of important coagulation factors, and the authors recommend that plasma not be transfused to simply correct this abnormal laboratory value.",
keywords = "Coagulation factor, International normalized ratio, Plasma, Prothrombin time, Transfusion",
author = "Kar{\'e}n Matevosyan and Christopher Madden and Barnett, {Samuel L.} and Beshay, {Joseph E.} and Cynthia Rutherford and Ravindra Sarode",
year = "2011",
month = "1",
doi = "10.3171/2010.7.JNS091699",
language = "English (US)",
volume = "114",
pages = "3--7",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "1",

}

TY - JOUR

T1 - Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time

T2 - Effect on plasma transfusion therapy: Clinical article

AU - Matevosyan, Karén

AU - Madden, Christopher

AU - Barnett, Samuel L.

AU - Beshay, Joseph E.

AU - Rutherford, Cynthia

AU - Sarode, Ravindra

PY - 2011/1

Y1 - 2011/1

N2 - Object. Neurosurgical patients often have mildly prolonged prothrombin time (PT) or international normalized ratio (INR). In the absence of liver disease this mild prolongation appears to be due to the use of very sensitive PT reagents. Therefore, the authors performed relevant coagulation factor assays to assess coagulopathy in such patients. They also compared plasma transfusion practices in their hospital before and after the study. Methods. The authors tested 30 plasma specimens from 25 patients with an INR of 1.3-1.7 for coagulation factors II, VII, and VIII. They also evaluated plasma orders during the 5-month study period and compared them with similar poststudy periods following changes in plasma transfusion guidelines based on the study results. Results. At the time of plasma orders the median INR was 1.35 (range 1.3-1.7, normal reference range 0.9-1.2) with a corresponding median PT of 13.6 seconds (range 12.8-17.6 seconds). All partial thromboplastin times were normal (median 29.0 seconds, range 19.3-33.7 seconds). The median factor VII level was 57% (range 25%-124%), whereas the hemostatic levels recommended for major surgery are 15%-25%. Factors II and VIII levels were also within the hemostatic range (median 72% and 118%, respectively). Based on these scientific data, plasma transfusion guidelines were modified and resulted in a 75%-85% reduction in plasma orders for mildly prolonged INR over the next 2 years. Conclusions. Neurosurgical patients with a mild prolongation of INR (up to 1.7) have hemostatically normal levels of important coagulation factors, and the authors recommend that plasma not be transfused to simply correct this abnormal laboratory value.

AB - Object. Neurosurgical patients often have mildly prolonged prothrombin time (PT) or international normalized ratio (INR). In the absence of liver disease this mild prolongation appears to be due to the use of very sensitive PT reagents. Therefore, the authors performed relevant coagulation factor assays to assess coagulopathy in such patients. They also compared plasma transfusion practices in their hospital before and after the study. Methods. The authors tested 30 plasma specimens from 25 patients with an INR of 1.3-1.7 for coagulation factors II, VII, and VIII. They also evaluated plasma orders during the 5-month study period and compared them with similar poststudy periods following changes in plasma transfusion guidelines based on the study results. Results. At the time of plasma orders the median INR was 1.35 (range 1.3-1.7, normal reference range 0.9-1.2) with a corresponding median PT of 13.6 seconds (range 12.8-17.6 seconds). All partial thromboplastin times were normal (median 29.0 seconds, range 19.3-33.7 seconds). The median factor VII level was 57% (range 25%-124%), whereas the hemostatic levels recommended for major surgery are 15%-25%. Factors II and VIII levels were also within the hemostatic range (median 72% and 118%, respectively). Based on these scientific data, plasma transfusion guidelines were modified and resulted in a 75%-85% reduction in plasma orders for mildly prolonged INR over the next 2 years. Conclusions. Neurosurgical patients with a mild prolongation of INR (up to 1.7) have hemostatically normal levels of important coagulation factors, and the authors recommend that plasma not be transfused to simply correct this abnormal laboratory value.

KW - Coagulation factor

KW - International normalized ratio

KW - Plasma

KW - Prothrombin time

KW - Transfusion

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