Intracranial procedures are often deferred until an international normalized ratio (INR) of less than 1.4 is achieved. There is no evidence that a moderately elevated INR is associated with increased risk of bleeding in neurosurgical intervention (NI). Thromboelastography (TEG) provides a functional assessment of clotting and has been shown to better predict clinically relevant coagulopathy compared with INR.
Traumatic brain injury (TBI) patients with an admission INR of greater than 1.4 had a longer time to NI. The use of plasma transfusion to decrease the INR may have contributed to this delay. A moderately elevated INR was not associated with coagulopathy based on TEG. Routine plasma transfusion to correct a moderately elevated INR before NI should be reexamined
Rowell SE, Barbosa RR, Lennox TC, Fair KA, Rao AJ, Underwood SJ, Schreiber MA. Moderate elevations in international normalized ratio should not lead to delays in neurosurgical intervention in patients with traumatic brain injury. J Trauma Acute Care Surg. 2014 Dec;77(6):846-851. PubMed PMID: 25423533.