Should INR be checked before all pleural procedures or only those who have bleeding risk factors?

<bold>Background:</bold> In the UK it is common practice to screen INR before pleural procedures. The BTS Clinical Statement on pleural procedures recommends an INR of ≤ 1.5. The most recent BTS Statement no longer recommends testing INR prior to pleural procedures when there are no known bleeding risks. <bold>Aim:</bold> Does universal INR screening identify patients with a deranged INR who would be missed by targeted INR screening? <bold>Methods:</bold> 3 existing databases of patients who had pleural procedures between 2019 and 2021 were used to identify a cohort of patients. INR test done in the year before the procedure were identified. A review of case notes was done to identify bleeding risk factors. <bold>Results:</bold> 230 patients were identified. 75 had a bleeding risk and 155 did not. Proportions with abnormal results are in Table 1. Identified bleeding risks were anticoagulation (n=45), liver disease (n=38) and haematological disease (n=15). A Number Needed to Test analysis was carried out and showed an NNT of 32.85. <fig><object-id>erj;64/suppl_68/PA2554/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> <bold>Conclusion:</bold> It was more common to have an elevated INR if an existing bleeding risk was identified. However, almost 5% of patients with no bleeding risk had an abnormal INR, which could increase their risk from a pleural procedure. Checking INR in all patients may continue to be an appropriate strategy to mitigate risk, especially in patients already undergoing blood sampling. Further multicentre studies would be required to confirm this work.