Acceptable INR level for epidurals?

Discussion in 'Pain Medicine' started by Ligament, May 29, 2008.

  1. Ligament

    Ligament Interventional Pain Management
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    What is your minimum acceptable INR level for epidurals?

    Some go for <1.5, some 1.2 or less. I go for 1.2 or less.

    ASRA guidelines do not specify a specific INR level as best I can tell.
     
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  3. 2win

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    1.2 just to save my headache.
     
  4. PMR 4 MSK

    PMR 4 MSK Large Member
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  5. lobelsteve

    lobelsteve SDN Lifetime Donor
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    1.5 acceptable, 1.2 preferred
     
  6. Tenesma

    Tenesma Senior Member

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    depends on what i am doing - anything cervical or lumbar TFESI/IESI it has to be <1.3... the 1.5 figure came from the surgical literature and is considered acceptable - but i would argue that we don't have the luxury of coagulating or holding pressure over an oozer/bleeder- therefore i don't believe the 1.5 really is acceptable for us...
     
  7. drrinoo

    drrinoo Rinoo Shah, MD

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    there is a hysteresis with respect to INR

    an INR of 1.5 conveys a different level of bleeding risk depending on whether a patient is started on anticoagulation vs. coming off of anticoagulation.

    1.0-->1.5

    2.0--> 1.5

    In these scenarios, INRs are the same (1.5) but they convey different bleeding risks

    I learned this a few years ago when I was preparing a manuscript on bleeding risk in IP:
     
  8. Ligament

    Ligament Interventional Pain Management
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    Interesting. So when you are doing procedures on your patients, what parameters do you use for an acceptable INR?

     
  9. Tenesma

    Tenesma Senior Member

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    nicole - 1.5 is acceptable in the surgical literature because they can apply pressure or cauterize bleeding - try doing that during a TFESI...
     
  10. GQPMR

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    Exact words as Tenesma earlier in this thread... She's done this on another thread as well. I believe we have a spammer here.
     
  11. Jeff05

    Jeff05 Senior Member

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    ASRA guidelines for REMOVAL is <1.5

    No number for placement offered by ASRA.

    Our institution uses 1.3 as a cutoff.
     

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