The relationship between INR and development of hemorrhage with placement of ventriculostomy

This study seeks to evaluate the relationship between the risk of symptomatic hemorrhage from ventriculostomy placement and International Normalized Ratio (INR) in patients who received a ventriculostomy after traumatic brain injury.

Patients who received a ventriculostomy after traumatic brain injury between June 2007 and July 2008 were identified and their medical records were abstracted for information.

At the time of ventriculostomy placement, 32 patients had an INR<1.2, 26 patients had an INR 1.2 to 1.4, 12 patients had an INR 1.4 to 1.6, and one patient had an INR>1.6 (INR=1.61). No significant difference in the risk of hemorrhage between the groups was observed: 9.4%, 3.9%, 8.3%, and 0%, respectively (p=0.73). In a subgroup analysis of patients who received ventriculostomy in the Neurosurgical Intensive Care Unit within 24 hours of admission (n=54), the average time between admission and ventriculostomy placement in patients who did not receive fresh frozen plasma was 6.8 hours compared with 9.3 hours (p=0.03) for those who did.

In this retrospective study, INRs between 1.2 and 1.6 appeared to be acceptable for a neurosurgeon to place an emergent ventriculostomy in a patient with traumatic brain injury.