International Normalized Ratio: Difference between revisions
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==Point-of-care testing== | ==Point-of-care testing== | ||
Point-of-care testing of the INR with a sample of blood obtained by fingerstick may<ref name="pmid9324174">{{cite journal| author=Bussey HI, Chiquette E, Bianco TM, Lowder-Bender K, Kraynak MA, Linn WD et al.| title=A statistical and clinical evaluation of fingerstick and routine laboratory prothrombin time measurements. | journal=Pharmacotherapy | year= 1997 | volume= 17 | issue= 5 | pages= 861-6 | pmid=9324174 | doi= | pmc= | url= }} </ref> or may not<ref name="pmid12842954">{{cite journal| author=Poller L, Keown M, Chauhan N, van den Besselaar AM, Tripodi A, Shiach C et al.| title=Reliability of international normalised ratios from two point of care test systems: comparison with conventional methods. | journal=BMJ | year= 2003 | volume= 327 | issue= 7405 | pages= 30 | pmid=12842954 | doi=10.1136/bmj.327.7405.30 | pmc=PMC164241 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12842954 }} </ref> be as reliable as an INR measured by a central laboratory. [[Clinical practice guideline]]s by the [[American College of Chest Physicians]] state "where possible, we suggest that personnel using POC office-based testing participate in proficiency schemes available through professional or national quality assurance organizations".<ref name="pmid18574265">{{cite journal| author=Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G et al.| title=Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). | journal=Chest | year= 2008 | volume= 133 | issue= 6 Suppl | pages= 160S-198S | pmid=18574265 | doi=10.1378/chest.08-0670 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18574265 }} </ref> | Point-of-care testing of the INR with a sample of blood obtained by fingerstick may<ref name="pmid9324174">{{cite journal| author=Bussey HI, Chiquette E, Bianco TM, Lowder-Bender K, Kraynak MA, Linn WD et al.| title=A statistical and clinical evaluation of fingerstick and routine laboratory prothrombin time measurements. | journal=Pharmacotherapy | year= 1997 | volume= 17 | issue= 5 | pages= 861-6 | pmid=9324174 | doi= | pmc= | url= }} </ref> or may not<ref name="pmid12842954">{{cite journal| author=Poller L, Keown M, Chauhan N, van den Besselaar AM, Tripodi A, Shiach C et al.| title=Reliability of international normalised ratios from two point of care test systems: comparison with conventional methods. | journal=BMJ | year= 2003 | volume= 327 | issue= 7405 | pages= 30 | pmid=12842954 | doi=10.1136/bmj.327.7405.30 | pmc=PMC164241 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12842954 }} </ref> be as reliable as an INR measured by a central laboratory. [[Clinical practice guideline]]s by the [[American College of Chest Physicians]] state "where possible, we suggest that personnel using POC office-based testing participate in proficiency schemes available through professional or national quality assurance organizations".<ref name="pmid18574265">{{cite journal| author=Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G et al.| title=Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). | journal=Chest | year= 2008 | volume= 133 | issue= 6 Suppl | pages= 160S-198S | pmid=18574265 | doi=10.1378/chest.08-0670 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18574265 }} </ref> | ||
==Self-monitoring of INRs by patients== | |||
"Compared to standard monitoring, patients who self-monitor or self-manage can improve the quality of their oral anticoagulation therapy. The number of thromboembolic events and mortality were decreased without increases in harms. However, self-monitoring or self-management were not feasible for up to half of the patients requiring anticoagulant therapy. Reasons included patient refusal, exclusion by their general practitioner, and inability to complete training" according to a [[meta-analysis]] by the [[Cochrane Collaboration]]. In this trial, the [[relative risk reduction]] of was 0%. In this population with a outcome of % without treatment, the [[number needed to treat]] is Infinity. <ref name="pmid20393937">{{cite journal| author=Garcia-Alamino JM, Ward AM, Alonso-Coello P, Perera R, Bankhead C, Fitzmaurice D et al.| title=Self-monitoring and self-management of oral anticoagulation. | journal=Cochrane Database Syst Rev | year= 2010 | volume= | issue= 4 | pages= CD003839 | pmid=20393937 | doi=10.1002/14651858.CD003839.pub2 | pmc= | url= }} </ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 21:07, 9 January 2011
The International Normalized Ratio (INR) is a "system established by the World Health Organization and the International Committee on Thrombosis and Hemostasis for monitoring and reporting blood coagulation tests. Under this system, results are standardized using the International Sensitivity Index for the particular test reagent/instrument combination used.[1]
It is a computation based on the prothrombin time (PT) and partial thromboplastin time (PTT).
Point-of-care testing
Point-of-care testing of the INR with a sample of blood obtained by fingerstick may[2] or may not[3] be as reliable as an INR measured by a central laboratory. Clinical practice guidelines by the American College of Chest Physicians state "where possible, we suggest that personnel using POC office-based testing participate in proficiency schemes available through professional or national quality assurance organizations".[4]
Self-monitoring of INRs by patients
"Compared to standard monitoring, patients who self-monitor or self-manage can improve the quality of their oral anticoagulation therapy. The number of thromboembolic events and mortality were decreased without increases in harms. However, self-monitoring or self-management were not feasible for up to half of the patients requiring anticoagulant therapy. Reasons included patient refusal, exclusion by their general practitioner, and inability to complete training" according to a meta-analysis by the Cochrane Collaboration. In this trial, the relative risk reduction of was 0%. In this population with a outcome of % without treatment, the number needed to treat is Infinity. [5]
References
- ↑ Anonymous (2024), International Normalized Ratio (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Bussey HI, Chiquette E, Bianco TM, Lowder-Bender K, Kraynak MA, Linn WD et al. (1997). "A statistical and clinical evaluation of fingerstick and routine laboratory prothrombin time measurements.". Pharmacotherapy 17 (5): 861-6. PMID 9324174. [e]
- ↑ Poller L, Keown M, Chauhan N, van den Besselaar AM, Tripodi A, Shiach C et al. (2003). "Reliability of international normalised ratios from two point of care test systems: comparison with conventional methods.". BMJ 327 (7405): 30. DOI:10.1136/bmj.327.7405.30. PMID 12842954. PMC PMC164241. Research Blogging.
- ↑ Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G et al. (2008). "Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).". Chest 133 (6 Suppl): 160S-198S. DOI:10.1378/chest.08-0670. PMID 18574265. Research Blogging.
- ↑ Garcia-Alamino JM, Ward AM, Alonso-Coello P, Perera R, Bankhead C, Fitzmaurice D et al. (2010). "Self-monitoring and self-management of oral anticoagulation.". Cochrane Database Syst Rev (4): CD003839. DOI:10.1002/14651858.CD003839.pub2. PMID 20393937. Research Blogging.