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Related Experiment Videos

Warfarin and the international normalized ratio: reducing interlaboratory effects.

G J Vanscoy1, J R Krause

  • 1Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh Medical Center, PA 15261.

DICP : the Annals of Pharmacotherapy
|November 1, 1991
PubMed
Summary

Warfarin dosing in North America was unintentionally increased due to less sensitive thromboplastins. Revised recommendations use the international normalized ratio (INR) to standardize results and reduce bleeding risks.

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Area of Science:

  • Pharmacology
  • Clinical Chemistry

Background:

  • Warfarin dosing in North America has been unintentionally increased over two decades.
  • This was due to less sensitive tissue thromboplastins affecting anticoagulation tests.
  • Revised warfarin dosing aims to reduce bleeding risk.

Purpose of the Study:

  • To address the issue of variable thromboplastin sensitivities in warfarin dosing.
  • To highlight the importance of the international normalized ratio (INR) for accurate prothrombin time (PT) reporting.

Main Methods:

  • Review of warfarin dosing practices and thromboplastin sensitivities.
  • Analysis of the impact of thromboplastin variability on PT results.
  • Evaluation of the role of INR in standardizing anticoagulation monitoring.

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Main Results:

  • Failure to recognize thromboplastin sensitivity led to increased warfarin doses.
  • Significant variability exists in thromboplastin sensitivity between manufacturers and lots.
  • Prothrombin times (PTs) are not comparable across laboratories without standardized thromboplastin.

Conclusions:

  • Revised warfarin dosing recommendations incorporate the international normalized ratio (INR).
  • Standardized tissue thromboplastin is crucial for accurate and comparable PT results.
  • Laboratories should report PT as an INR unless a standardized thromboplastin is adopted.