A 64-year-old male patient diagnosed with atrial fibrillation is started on anticoagulant therapy with warfarin to...

A 64-year-old male patient diagnosed with atrial fibrillation is started on anticoagulant therapy with warfarin to lower his risk of stroke due to fibrin clots. Despite calculating initial warfarin dosing based on the patient’s age, weight, and sex, laboratory monitoring of anticoagulant activity after the first week of therapy shows that the patient is receiving too much warfarin (his INR was too high indicating he is “over anti-coagulated”). After several weeks of dose adjustment, the patient’s anticoagulant therapy is optimized at a warfarin concentration that is 10-fold lower than the initial dose.

a. What is INR? What is normal INR? What does low INR mean? High INR?

Expert Solution

INR - The international normalized ratio or INR is a calculation based on results of a PT (The prothrombin time (PT) is a test that helps evaluate your ability to appropriately form blood clots) that is used to monitor individuals who are being treated with the blood-thinning medication (anticoagulant) warfarin.

HOW IS INR CALCULATED ? The INR is derived from prothrombin time (PT) which is calculated as a ratio of the patient's PT to a control PT standardized for the potency of the thromboplastin reagent developed by the World Health Organization (WHO) using the following formula: INR = Patient PT ÷ Control PT.

Warfarin is a racemic mixture of isomers that inhibits the synthesis of vitamin K-dependent coagulation factors. The effective dose of warfarin varies significantly among individuals, as a result of genetic variations in its receptor, metabolism via the cytochrome P450 (CYP) system and interactions with other drugs, vitamins and green vegetables.

NORMAL INR - In healthy people an INR of 1.1 - 1.5 is considered normal.

LOW INR - blood clots will not be prevented, A low INR result means your blood is 'not thin enough' or coagulates too easily and puts you at risk of developing a blood clot. PATIENTS HAVING LOW INR = BLOOD CLOT = HIGH RISK OF STROKE

INR VALUE WHEN UNDER ANTI COAGULANT TREATMENT - the therapeutic INR ranges between 2.0 to 3.0. INR

HIGH INR - it simply means that the patient is over anticoagulated , if under accident, it can result to heavy blood loss, bleeding, increase in blood pressure, complications in surgery and treatment. Levels above 4.9 are considered critical values and increase the risk of bleeding

INR CAN VARY UPON THE TREATMENT PLAN AND TARGET, FOR EXAMPLE

For patients with a mechanical mitral prosthetic valve (including On-X valve) or mechanical tricuspid prosthetic valve, the target INR is 3.

Nightingale answered 1 year ago

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