Periprocedural Major Bleeding Risk of Image-Guided Percutaneous Chest Tube Placement in Patients with an Elevated International Normalized Ratio

Navin, Patrick J.; White, Mariah L.; Nichols, Francis C.; Nelson, Darlene R.; Mullon, John J.; McDonald, Jennifer S.; Atwell, Thomas D.; Moynagh, Michael R.

doi:10.1016/j.jvir.2019.07.002

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…2,3 In these settings, the ultrasound-guided chest drain position is a valid tool to reduce complication rates and bleeding risks, especially in patients with increased hemorrhagic risk. 4 Usually, main complications during chest tube insertion are related to malposition, organ damage, tube replacement, or hemothorax; the use of small-bore tubes may reduce complications during the procedure. 5,6 Moreover, ultrasonography has been used especially in pediatric patients to monitor the transit and position of ingested foreign bodies, showing potential advantages in terms of reduced ionizing radiation exposure and patient mobilization.…”

Section: Discussionmentioning

confidence: 99%

Intrapleural Foreign Body in a Critically Ill Patient

Chiappetta

Sassorossi

Lococo

et al. 2022

CHEST

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Section: Discussionmentioning

confidence: 99%

Intrapleural Foreign Body in a Critically Ill Patient

Chiappetta

Sassorossi

Lococo

et al. 2022

CHEST

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“…Some previous studies agreed that high INR values strongly correlate with the risk of bleeding in heart valve replacement and head trauma 37 , 38 , 39 . However, others observed that an elevated INR did not increase bleeding risk in chest tube placement or hand surgery 54 , 55 . In our study, we found that with management by the ERAS protocol in THA surgery, the influence of an elevated INR above the conventional safety threshold (<1.5) on blood transfusion and complications was relatively small.…”

Section: Discussionmentioning

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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“…Some previous studies agreed that high INR values have a strong association with the risk of bleeding in heart valve replacement and head trauma [14][15][16]. But some others observed that an elevated INR did not increase bleeding risk in chest tube placement and hand surgery [31,32].…”

Section: Discussionmentioning

confidence: 99%

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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Periprocedural Major Bleeding Risk of Image-Guided Percutaneous Chest Tube Placement in Patients with an Elevated International Normalized Ratio

Cited by 8 publications

References 16 publications

Intrapleural Foreign Body in a Critically Ill Patient

Intrapleural Foreign Body in a Critically Ill Patient

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

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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