298 Failure to Correct International Normalized Ratio Following Fresh Frozen Plasma Administration Among Patients With Anticoagulant-Related Major Bleeding in Clinical Practice

Abstract

To assess the frequency of international normalized ratio (INR) remaining uncorrected in patients administered fresh frozen plasma for anticoagulant-related major bleeding. A retrospective database analysis was undertaken using electronic medical record data from a large integrated health system. Patients who received fresh frozen plasma between 01/01/2004 and 12/31/2010, and who met the following criteria were selected: major hemorrhage diagnosis the day before to the day after initial fresh frozen plasma administration; INR≥2 on the day before or the day of fresh frozen plasma and another INR result up to 1 day after fresh frozen plasma; and supply of warfarin within 90 days prior to hospitalization. INR correction (defined as INR ≤ 1.3) was evaluated at the last available test up to 1 day following fresh frozen plasma start. Logistic regression analysis was performed to assess probability of remaining uncorrected. 414 patients met selection criteria (mean age 75 years, 53% male, mean baseline Charlson score of 2.5). The majority of patients presented with a gastrointestinal bleed (58%), followed by intracranial hemorrhage (ICH) (38%) and other bleed types (4%). Mean 1st elevated INR was 3.7, and mean INR was 1.5 at the last test. Sixty-seven percent of patients remained uncorrected. Mean time to correction among those achieving correction was 20.6 hours from start of fresh frozen plasma administration. Patients who were older, those with a baseline Charlson score of 4 or greater, and those with non-ICH bleeds were more likely to remain uncorrected within 24 hours of fresh frozen plasma administration. Using an INR threshold of ≤ 1.5, 39% of patients remained uncorrected. A substantial proportion of patients remain uncorrected following fresh frozen plasma administration, with estimates varying depending on the INR threshold used.