Walking the Razor's Edge—Anticoagulation-induced Intracerebral Hemorrhage and the Perplexity in Choosing between International Normalized Ratio and Point-of-care Tests as a Reliable, Definitive, Coagulation Testing Parameter in Neurosurgical Management

JOURNAL TITLE: Research and Innovation in Anesthesia

Author
1. Ankit Gupta
2. Vaishali Kulkarni
3. Joanna S Rodrigues
ISSN
DOI
10.5005/jp-journals-10049-0088
Volume
5
Issue
2
Publishing Year
2020
Pages
3
Author Affiliations
    1. Department of Anaesthesiology, Global Hospital, Parel, Mumbai, Maharashtra, India
    1. Department of Anesthesia, Global Hospital, Mumbai, Maharashtra, India
    1. Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
    2. PGIMER and Dr RML Hospital, New Delhi, India
  • Article keywords
    International normalized ratio, Neurosurgery, Thromboelastography (TEG), Warfarin

    Abstract

    Urgent reversal of anticoagulation in patients on warfarin therapy for neurosurgical procedures can be quite tricky as well as risky. Anticoagulation reversal using blood products has its own challenges and their administration must be guided with effective, investigative tools such as international normalized ratio (INR) and point-of-care coagulation tests. However, the superiority of either in neurosurgical procedures has not been established. Hence, a careful risk calculation must be done considering the overall clinical picture of the patient as well. We present a case report in which we faced such a dilemma.

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