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Side-Effects of COVID-19 on Patient Care: An INR Story

Lauren N Pearson1, Stacy A Johnson2, Dina N Greene3

  • 1Department of Pathology, University of Utah, Salt Lake City, UT, USA.

The Journal of Applied Laboratory Medicine
|March 24, 2021
PubMed

Insights

The COVID-19 pandemic reduced International Normalized Ratio (INR) testing, particularly for outpatients. This led to more high INR results, increasing bleeding risks and highlighting the need for improved monitoring strategies.

Area of Science:

  • Clinical Medicine
  • Pharmacology
  • Public Health

Background:

  • The COVID-19 pandemic significantly disrupted patient care, affecting access to essential medical services and treatments.
  • Reduced access to care may lead to suboptimal management of conditions like venous thromboembolism, potentially impacting therapies such as warfarin.
  • International Normalized Ratio (INR) testing is crucial for monitoring warfarin therapy effectiveness and safety.

Purpose of the Study:

  • To investigate the impact of the COVID-19 pandemic on the utilization of International Normalized Ratio (INR) testing.
  • To determine changes in the percentage of high (≥3.5) and low (≤1.5) INR results during the pandemic.
  • To compare INR testing patterns between inpatient and outpatient settings during the pandemic.

Main Methods:

  • Retrospective analysis of INR data from 11 institutions, comparing pre-pandemic (Jan-June 2019) and pandemic (Jan-June 2020) periods.
  • Evaluation of testing volumes and the proportion of supratherapeutic (≥3.5) and subtherapeutic (≤1.5) INR results.
  • Stratification of data into inpatient and outpatient cohorts for comparative analysis.

Main Results:

  • INR testing volumes remained stable in early 2020 but significantly decreased from March to May, returning to baseline in June.
  • Outpatient INR testing experienced a more substantial decline in volume compared to inpatient testing.
  • An increase in the percentage of high INR results (≥3.5) was observed at 10 of 11 sites, predominantly in the outpatient group, correlating with decreased testing volumes.

Conclusions:

  • The COVID-19 pandemic adversely affected INR testing, particularly among outpatients, potentially due to reduced laboratory access and healthcare utilization.
  • The observed increase in supratherapeutic INR results during the pandemic raises concerns about elevated bleeding event risks in patients on warfarin.
  • Future strategies, including drive-through testing and widespread home INR monitoring, may mitigate these risks and improve patient safety.
Abstract

Keywords:
COVID-19INRhealth care access

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