PT, PTT and platelet counts as predictors of bleeding lack
specificity. Prophylactic treatment of patients undergoing minimally invasive
procedures with blood products targeted at specific PT, PTT, INR and PLT counts
is probably not indicated in many cases. If any of these patients bleed
excessively it is often not from moderate coagulopathy (as defined by these 3
tests), but for other reasons. Rather, platelets and FFP are best
used to treat a significant bleed and not to prevent one. To mention just a few - The University of Kansas
Medical Center, Massachusetts General Hospital, and 25 hospitals in the
Province of Ontario, Canada have
adopted performing such minimally invasive procedures with an INR of 2.0 and a
platelet count of 30, 000.
Implementation of these new transfusion triggers can decrease
length of stays for our patients because of decreased transfusion transmitted
immune modulation (less pneumonia and less UTIs), decrease procedural delays
from the requirement to transfuse platelets and FFP and decrease transfusion
reactions.
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Approved UKY Practice Guidelines for
Minimally Invasive Bedside Procedures for Non-Emergent Cases
|
||
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1.5 INR, 50,000 Platelets
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1.8 INR, 40K Plt
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2.0 INR, 30,000 Platelets
|
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Transbronchial,
debridement, tumor de-bulking
|
Liver Biopsy
|
PICC line
|
|
GI Polypectomy and
biopsies
|
Central Line -ultrasound
guided IJ access
|
|
|
Central Line –
Subclavian, Femoral
|
|
GI Endoscopy Screening
without biopsy
|
|
Renal Biopsy
|
|
Bronchoscopy brush,
wash, thin needle, EUB
|
|
LP
|
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Thoracentesis
|
|
|
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Paracentesis
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Note: “While many practice guidelines recommend INR 1.5 and
platelet count 50,000, it is recognized that in some patients it may not be
achievable or practical to bring the INR to 1.5 or platelet count to
50,000. There is evidence that these minimally invasive bedside
procedures can be and are done safely at higher INRs and lower platelet
counts. In these patients the clinical diagnostic need for the procedure
may outweigh risks associated with INR or platelet count values.” (Dr. C. D.
Jennings)
