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The INR is a largely useless predictor of bleeding risk except for those on coumadin/warfarin, and not so good a predictor in those patients. It is known that the range of 2-3 is a reasonably safe and effective one for anti-coagulation to prevent recurrent thrombosis (usually DVT or PE). Beyond that, INR numbers like 6 or 12 tell us next to nothing except that factor VII is quite low, which may or may not be clinically important. The INR of liquid plasma or FFP is around 1.6-1.8, and is not affected by the citrate anticoagulant, since exogenous excess calcium is added in the performance of the INR. INRs of 1.5 to about 2.0 are not associated with substantial increases in bleeding, either spontaneous or procedure related, and do not need to be corrected at all, in my view, and this opinion is supported by an extensive observational literature. FFP will not correct such an INR in any case, and thus represents risk without benefit. Medical specialty society recommendations for INRs of 1.5 prior to procedures are without any evidence support whatever, and represent old, no longer valid expert opinion. If an INR needs correction for any reason, factor concentrates are more effective and less likely to harm the patient than FFP. FFP should never be used to reverse warfarin/coumadin in my opinion, because of these efficacy and safety issues. Unfortunately factor concentrates are also much more expensive than plasma/FFP. However, this considers only the cost of the product, not the cost of any clinical complications such as thrombosis, volume overload, ICU admission, etc., not to mention death, all of which are more likely with plasma/FFP. Meta-analyses of randomized trials of FFP vs. factor concentrate, demonstrate that FFP is associated with a two fold mortality increase. 'Nuf said. One ICU admission for a few days can balance the increased costs of factor concentrates for the overall health system. Factor concentrates, preferably II, VII, IX, X concentrates that also contain some protein S and C; in the USA=Kcentra; in Europe=Beriplex are preferred over three factor concentrates, but both are superior to FFP.

Amazing how conservative they can be with transfusions when motivated.

Double yikes!

Why is the bedside type "going away?" We do that and have for years (decades), which has saved us on several occasions. It's cheap, easy and quick. Just curious.