headache, elevated INR, CT negative. what now?

3 Jun

RAGING HYPOTHETICAL:

Your next patient is a 60 yo female with a severe, acute onset headache.

She recently had an elevated INR on routine check and was stopped on her Coumadin.

CT is negative (no bleed).  

 

 

Yet, you’re still worried about a SAH…

 

CAN YOU LP?

According to uptodate, there are no studies that have quantified bleeding risk in patients with thrombocytopenia or coagulopathy after LP.

 

Recommend:

No LP until correction in patients with

  • plts < 50-80K,
  • active bleeding,
  • INR > 1.4

 

You can always treat empirically (FFP/vitamin K, etc).

 

Submitted by J. Rothstein.

 

References: uptodate article; picture

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