Archana T. Laroia MD, Presenter: Nothing to Disclose

Sandeep T. Laroia MD, Abstract Co-Author: Nothing to Disclose

INR remains a much used laboratory parameter to evaluate bleeding diathesis in patients with liver disease. Based on elevated INR value, the patient is often treated with either Vitamin K or fresh frozen plasma (FFP), especially if the patient has to undergo a guided invasive intervention like liver biopsy or TIPS procedure. However clinically significant bleeding from the intervention site remains rare. FFP infusions remain a routine clinical practice despite the potential for significant adverse effects as well as significant resource utilization. A more reliable test is Thromboelastography (TEG), which is evaluated against INR.

Thirty one patients with liver disease induced bleeding diathesis (defined as INR> 1.5) were studied. TEG was obtained and patients’ clinical course was followed. Various parameters of TEG test as well as other anticoagulant protein levels were studied where available.

Twenty two (73%) of the patients with elevated INR had TEG parameters within normal limits. These patients also maintained normal hemostasis during their clinical course. Remaining nine (27%) patients had abnormal INR as well as abnormal TEG parameters. Three (33%) of these patients showed evidence of clinically significant bleeding.

Measuring TEG parameters is a better way to assess hemostasis in patients with liver injury rather than relying solely upon INR. INR is a measure of procoagulants only where as TEG is more comprehensive as it measures both the  procoagulant and anticoagulant protiens. This change in Interventional Radiology practice would not only avoid potential harm from aggressive FFP infusions but also be cost effective.

Using Thromboelastography (TEG) instead of INR alone in Interventional Radiology practice would not only avoid potential harm from aggressive measures like FFP infusions, but also be cost effective.

Laroia, A, Laroia, S, Looking beyond International Normalized Ratio (INR) in Liver Interventions.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13024339.html