Neuraxial anesthesia after Coumadin reversal

[etomidator3]

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What do people do concerning neuraxial anesthesia after patients have their INR corrected??? Will you do a neuraxial block when the INR reaches normal? If not, how long do you wait?????

 

[pgg]

What do people do concerning neuraxial anesthesia after patients have their INR corrected??? Will you do a neuraxial block when the INR reaches normal? If not, how long do you wait?????

Sure, INR <=1.4, stick away.

 

[B-Bone]

In my experience, FFP rarely gets the INR down to a level i'd feel comfortable doing a neuraxial procedure. It seems to get stuck at 1.5-1.6. Also, if you're giving FFP solely to get the INR down to do a spinal, I think the downside of the FFP is probably worse than the downside of the GETA (situation dependent, of course).

 

[ssmallz]

The typical view is <1.4 you're ok to do neuraxial techniques. I'm a bit more conservative in the pt population that requires FFP to lower the INR to an acceptable level. We all know that INR measures only a fraction of the overall clotting cascade so this population may still be at risk even w/an INR in the acceptable range. While I don't have an absolute cut off in this pt population my general approach is to avoid it unless there is an overwhelming benefit from a neuraxial technique