Epidural catheters can be removed safely despite international normalized ratios higher than 1.4 during the initiation of warfarin therapy, according to a study reported in Anesthesiology News.
The study examined 4,365 patients who were undergoing total joint replacement followed by daily warfarin thromboprophylaxis. All patients had normal coagulation test results prior to surgery, and nonsteroidal and anti-inflammatory drugs were withheld prior to surgery.
Epidural analgesia was discontinued, and only patients with an international normalized ratio greater than 1.4 upon catheter removal were included in the study. According to the report, current American Society of Regional Anesthesia and Pain Medicine guidelines state that epidural catheters should not be removed if the INR level is above 1.4
Patients were followed twice a day by the acute pain service and underwent two neurologic checks for 24 hours after removal. The researchers reported that although the mean INR at the time of removal was above the recommended 1.4, no spinal hematomas were observed in the patients.
Read the Anesthesiology News report on epidural catheters.
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The study examined 4,365 patients who were undergoing total joint replacement followed by daily warfarin thromboprophylaxis. All patients had normal coagulation test results prior to surgery, and nonsteroidal and anti-inflammatory drugs were withheld prior to surgery.
Epidural analgesia was discontinued, and only patients with an international normalized ratio greater than 1.4 upon catheter removal were included in the study. According to the report, current American Society of Regional Anesthesia and Pain Medicine guidelines state that epidural catheters should not be removed if the INR level is above 1.4
Patients were followed twice a day by the acute pain service and underwent two neurologic checks for 24 hours after removal. The researchers reported that although the mean INR at the time of removal was above the recommended 1.4, no spinal hematomas were observed in the patients.
Read the Anesthesiology News report on epidural catheters.
Related Articles on Anesthesia:
Washington University School of Medicine Anesthesiologist Dies in Cycling Accident
Anesthesiologist Presence Improves Polyp Detection Rate
Parents More Likely to Quit Smoking if Child Undergoes Surgery