Management of anticoagulation therapy with the International Normalized Ratio

Nurse practitioners have both the education and the counseling skills to evaluate and manage patients receiving warfarin therapy. The benefits of such treatment should be weighed against potential risk before initiation of therapy. Patients receiving warfarin need to be closely monitored because of the narrow therapeutic range of the drug. The INR system provides the most consistent results of dose response to warfarin, but has not been adopted by all laboratories. Patients should be counseled on the need for accurate laboratory testing. Testing should be done at the same laboratory, and by one that uses the INR system. Until a standardized and sensitive thromboplastin is produced by recombinant technology, the INR system is the most practical and clinically useful method of monitoring anticoagulation therapy.