[Current biological surveillance of oral anticoagulant treatment]

The prothrombin time is the coagulation time of citrated plasma in the presence of calcium and a tissue extract, thromboplastin, added in excess. The prothrombin time was historically the first method of evaluation and control of oral anticoagulation. Over the years, the different thromboplastins have changed, diversified, so affecting the result of the prothrombin ration established from the prothrombin time and a reference curve. In 1985, the International Committee on Thrombosis and Haemostasis requested that all the losts of thromboplastin have their international sensitivity index (ISI) indicated. This allowed uniformity of the results by the introduction of the INR (International Normalized Ratio) calculated by the formula: INR = (PTR)ISI, the PTR or prothrombin time ratio corresponding to the patients' prothrombin time divided by that of reference control plasma. It is, in fact, impossible to interpret the results of a prothrombin ration without knowing their expression in INR. The consequences of the absence of uniformity in the control of anticoagulant therapy are important and serious. The uncertainty concerning the degree of anticoagulation inherent in the use of a single prothrombin ratio may be the source of bleeding or thromboembolic complications. Curiously, the system based on the INR is neither generalised, nearly 10 years after its recommendation, nor adopted by the majority of practitioners. However, the stakes are high because the principal complication of oral anticoagulants remains bleeding, including the dramatic strokes. Moreover, the global mortality due to haemorrhagic complications is about 0.1 to 0.5% for treatments of short duration and much higher in prolonged therapy.(ABSTRACT TRUNCATED AT 250 WORDS)