Related Experiment Video

Updated: Jul 11, 2025

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
11:17

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

Published on: October 12, 2012

13.8K

Elevated International Normalized Ratio and Mortality in Hospitalized Patients Treated with Direct Oral

Orly Efros1, Aya Berman2, Gili Kenet3

  • 1National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Faculty of Medicine, Tel Aviv University, Israel.

The American Journal of Medicine
|November 5, 2023
PubMed

Insights

Elevated international normalized ratio (INR) in patients on direct oral anticoagulants (DOACs) indicates higher in-hospital and one-year mortality risks. These INR levels are significant prognostic markers, not just lab variations.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Direct oral anticoagulants (DOACs) can prolong prothrombin time and elevate the international normalized ratio (INR).
  • The clinical implications of these INR changes in patients on DOACs remain unclear.
  • Understanding the prognostic value of admission INR is crucial for managing these patients.

Purpose of the Study:

  • To investigate the association between elevated admission INR and outcomes in hospitalized patients treated with DOACs.
  • To determine if admission INR predicts in-hospital mortality and long-term survival.

Main Methods:

  • Retrospective analysis of 11,399 hospitalized patients treated with DOACs.
  • Data collected from Sheba Medical Center between November 2008 and July 2023.
  • INR levels measured within 48 hours of hospitalization were analyzed for association with mortality.

Main Results:

  • Patients with elevated INR had a 180% higher risk of in-hospital death (aOR 2.80).
  • A 57% increased risk of one-year mortality was observed (aHR 1.57).
  • Results were consistent across different DOACs in subgroup analyses.

Conclusions:

  • Elevated admission INR in DOAC-treated patients is a significant predictor of mortality.
  • These findings suggest elevated INR should be considered a prognostic marker, not merely a laboratory artifact.
  • This highlights the importance of monitoring INR in hospitalized patients on DOACs.
Abstract

Keywords:
Direct oral anticoagulantsIn-hospital mortalityInternational normalized ratio

More Related Videos

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control05:41

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control

Published on: December 16, 2022

3.5K
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock06:10

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

3.3K

Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.2K
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
719
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
10
Therapeutic Index01:13

Therapeutic Index

The therapeutic index of a drug is a key parameter in pharmacology that quantifies the relative safety of a drug by calculating the ratio between the dose that causes toxicity in half the population (50%) to the dose that proves to be effective for half the population (50%). It provides a spectrum of doses for a particular drug ranging from effective to potentially toxic. To illustrate, consider an anticoagulant agent like warfarin. It possesses a narrow window within its therapeutic index to...
4.3K
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors01:20

Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors

Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
535
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
10