Elevated International Normalized Ratio Is Not Associated With Increased Perioperative Morbidity in Podiatric Limb Salvage Surgery: A Retrospective Analysis

J Foot Ankle Surg. Jul-Aug 2018;57(4):761-765. doi: 10.1053/j.jfas.2018.02.013. Epub 2018 May 8.


The risk of hemorrhage always exists in anticoagulated patients with an elevated international normalized ratio (INR), a risk that must be measured against the necessity for surgical procedures. The objective of the present retrospective medical record study was to assess the safety with which limb salvage procedures can be conducted in patients with an INR >1.4. The medical records of 231 patients who had undergone limb salvage procedures by 1 surgeon at the Yale New Haven Health System from November 2008 through July 2014 were reviewed. All patients were administered foot blocks with monitored intravenous sedation. The patients' demographic data, comorbidities, preoperative anticoagulant use, coagulation profile, intraoperative analgesic administration, estimated blood loss, total operating room time, total postanesthesia care unit time, intraoperative ankle tourniquet use, and postoperative complications within the initial 72 hours were reviewed. We found no differences in intraoperative bleeding, total intraoperative time, or recovery time between the INR <1.4 group (n = 212) and the INR >1.4 group (n = 19). None of the patients experienced any postoperative complications, defined as any cardiac or pulmonary event, the need for invasive monitoring, or admission to the intensive care unit within the initial 72-hour period. Our findings suggest that patients are suitable for undergoing peripheral procedures with foot blocks and monitored intravenous sedation even in the presence of an elevated INR.

Keywords: bleeding; coagulation; foot surgery; patient safety; peripheral vascular disease.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Foot*
  • Humans
  • International Normalized Ratio*
  • Intraoperative Complications / epidemiology*
  • Limb Salvage*
  • Male
  • Middle Aged
  • Patient Selection
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Factors