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Authors: Parvizi J, Saxena A, Baratz M., Jaberi F, Barr S

Title: INR, Coagulopathy, and Anesthesia in Periprosthetic Infection

Institution: Rothman Institute, Philadelphia, PA

Purpose: The present study observed patients with periprosthetic infection who had elevated INR and were precluded from receiving regional anesthesia. We hypothesize that a PPI can result in an abnormal coagulation profile that may not be correctable.

Methods: Over 8 years, we retrospectively reviewed 294 patients admitted for PPI. We compared the outcomes of patients that underwent attempted INR normalization with FFP and/or vitamin K prior to surgery with those that did not receive normalization treatment. INRs upon admission and immediately prior to surgery were recorded.

Results: Statistical analysis showed that our groups were similar and that the use of Vitamin K,FFP, or both had no effect on the preoperative INR compared to the non treatment group.

Discussion and Conclusion: The presence of organisms around a joint can result in activation of an inflammatory process, which may disrupt coagulation. This coagulopathy, as evidenced by abnormal INR, may not be reversible by standard treatments. It is our belief that attempting to correct coagulopathy in the presence of PPI is a process that often fails and can cause potential harm.

Musculoskeletal Infecton Society
Musculoskeletal Infecton Society