I don’t know who needs to hear this but FFP does NOT normalize INR. The lowest you can get an INR down to with FFP is ~1.6. So stop giving it to reverse patients with INRs ≤ this value. It doesn’t work.
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Replying to @EM_RESUS @RosenelliEM
I've heard this a fair amt. Was taught this as a resident. And I don't think it's correct. (It's likely not clinical issue since FFP not rec'd to reverse warfarin, not useful in liver dz/balanced coagulopathy, etc.) Any Tox and pathophys folk want to weigh in here?
@bobhoffmd1 reply 0 retweets 3 likes -
Agreed. Pretty sure
@bobhoffmd + Mary Ann Howland told me this is not true in terms of “INR of FFP”1 reply 0 retweets 2 likes -
You guys are confusing two different concepts. I didn’t say the “INR of FFP is ~1.6”. I said the lowest you can get an INR down to with FFP is ~1.6. This is what studies show and is explained by the concept of diminishing returns.
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Are these the in vitro studies that show poor correction past 1.6? Because in that case, I amend my objection to: you can probably correct fully in vivo but if you care about speed, not sure you should try.
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Diminishing returns: https://www.grepmed.com/images/2463 pic.twitter.com/jOBrwtdm4w
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Replying to @grepmeded @EM_RESUS and
Thanks! Hadn't seen this graph before. My thought was: in vitro studies never totally correct, in vivo total reversal occurs, but more slowly than you'd like. I didn't really have the concept of diminishing returns before, but this was my take home: https://www.mayoclinicproceedings.org/article/S0025-6196(13)00035-9/fulltext …pic.twitter.com/DDF6fjuYlw
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Sorry that wasn't in answer to your question but towards the general thread. Should give credit to @iEMPharmD from where that image was found (apparently INR FFP = 1.1):https://empharmd.com/2018/05/21/what-is-the-inr-of-ffp/ …
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