![]() Intramuscular (IM) administration of vitamin K, an anticoagulant reversal drug, may be requested by the HCP. Monitor vital signs, unusual ecchymosis, occult blood, severe headache, unusual dizziness, and neurological changes until PT/INR is within the expected range. Important signs to note relate to bleeding in specific areas of the body and include prolonged bleeding from cuts or gums, hematoma at a puncture site, hemorrhage, blood in the stool, backache or flank pain, dark-colored urine, joint pain, persistent epistaxis, heavy or prolonged menstrual flow, and shock. Policies vary among facilities and may include requesting immediate recollection and retesting by the laboratory or retesting using a rapid point-of-care testing instrument at the bedside, if available. A listing of these findings varies among facilities.Ĭonsideration may be given to verification of critical findings before action is taken. Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. INR = 2.5 to 3.5 for patients receiving intensive anticoagulation therapy with warfarin.Ĭritical Findings and Potential Interventions INR.INR = 2 to 3 for patients receiving conventional anticoagulation therapy with warfarin.Values may be slightly higher in newborns and children less than 1 yr. INR = 0.9 to 1.1 for patients not receiving anticoagulation therapy.There are no food, fluid, activity, or medication restrictions unless by medical direction. Warfarin is an effective medication, but it must be closely monitored due to a significant risk for bleeding. Prothrombin time (PT)/international normalized ratio (INR) is a frequently requested test used to monitor patients at risk for developing blood clots, heart attack, or stroke especially those who receive treatment with warfarin, an oral vitamin K antagonist. Normal, abnormal, or various combinations of core lab study results can indicate that all is well, reveal a problem that requires further investigation with additional testing, signal a positive response to treatment, or suggest that the health status is as expected for the associated situation and time frame. The designation is meant to assist the reader in sorting the basic “always need to know” laboratory studies from the hundreds of other valuable studies found in the manual-a way to begin putting it all together. It makes no significant contribution to the diagnosis or treatment of patients whose PT is prolonged for other reasons.To assess and monitor coagulation status related to therapeutic interventions and disorders such as vitamin K deficiency.Ī small group of studies in this manual have been identified as Core Lab Studies. The INR is used only for patients on stable oral anticoagulant therapy. INR = (Patient’s PT/mean PT of reference range) ISI where: More sensitive thromboplastins have a low ISI (1.0-1.2), whereas less sensitive thromboplastins have a higher ISI (eg, 2.0-3.0). The international sensitivity index (ISI) is an experimentally derived measurement, usually provided by the thromboplastin manufacturer, reflecting thromboplastin (and PT) sensitivity to coagulation deficiencies. The INR is the ratio of the patient’s PT to the laboratory’s mean normal (reference) PT. ![]() The international normalized ratio (INR) is a method of standardizing PT reporting for monitoring the intensity of oral anticoagulant therapy. The PT requires standardization because there are numerous thromboplastins and coagulation testing instruments, and they all vary in their responsiveness to the concentrations or activities of coagulation proteins. Oral anticoagulants reduce the activities of the 4 vitamin K-dependent procoagulant factors (factors II, VII, IX, and X), and the PT is sensitive to 3 of them. The PT is the most common test used for monitoring oral anticoagulant therapy (warfarin or Coumadin, and congeners). A prolonged PT indicates deficiency of 1 or more coagulation factors (I, II, V, VII, or X) or the presence of a coagulation inhibitor. The prothrombin time (PT) represents the time elapsed between 1) addition of a standardized mixture of tissue thromboplastin and calcium to citrate anticoagulated plasma and 2) detection of clot formation, representing fibrin polymerization resulting from the generation of thrombin, which proteolytically transforms fibrinogen to fibrin.
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