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How is it used? The prothrombin time (PT) is used, often along with a partial thromboplastin time (PTT), to help diagnose the cause of unexplained bleeding or inappropriate blood clots. The international normalized ratio (INR) is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication () warfarin (Coumadin®). Several proteins called coagulation factors are involved in the process that the body uses to form blood clots to help stop bleeding (hemostasis).
When an injury occurs and bleeding begins, some coagulation factors are activated in a sequence of steps (coagulation cascade) that eventually help to form a clot. There must be a sufficient quantity of each coagulation factor, and each must function properly, in order for normal clotting to occur. Too little can lead to excessive bleeding; too much may lead to excessive clotting. (See the "What is being tested?" section for more on this.
) The PT and INR are used to monitor the effectiveness of the anticoagulant warfarin. This drug affects the function of the coagulation cascade and helps inhibit the formation of blood clots. It is prescribed on a long-term basis to people who have experienced recurrent inappropriate blood clotting. The goal of warfarin therapy is to maintain a balance between preventing clots and causing excessive bleeding.
This balance requires careful monitoring. The INR can be used to adjust a person's drug dosage to get the PT into the desired range that is right for the person and his or her condition. Warfarin may be prescribed for conditions such as: The PT test may be used along with a PTT as the starting points for investigating excessive bleeding or clotting disorders. The PT evaluates the coagulation factors VII, X, V, II and I (fibrinogen).
The PTT test evaluates coagulation factors XII, XI, IX, VIII, X, V, II (prothrombin), and I (fibrinogen) as well as prekallikrein (PK) and high molecular weight kininogen (HK). By evaluating the results of the PT and PTT together, a health practitioner can gain clues as to what bleeding or clotting disorder may be present. These tests are not diagnostic by themselves but usually provide information on whether further tests may be needed.
Examples of other testing that may be done along with a PT and PTT or in follow up to abnormal results include: Platelet count – to determine if platelets are decreased, which can cause excessive bleeding Thrombin time testing – sometimes ordered to help rule out a fibrinogen abnormality Fibrinogen testing – may be done to rule out a low level or dysfunction of fibrinogen as a cause of a prolonged PT Coagulation factor tests – these measure the activity (function) of coagulation factors.
They can detect reduced levels of the protein or proteins that don't work properly (have reduced function). Rarely, the antigen level (quantity) of a coagulation factor may also be measured. von Willebrand factor – sometimes ordered to help determine if von Willebrand disease is the cause of a prolonged PTT Based on carefully obtained patient histories, the PTT and PT tests are sometimes selectively performed as pre-surgical or before other invasive procedures to screen for potential bleeding tendencies.
^ Back to top When is it ordered? A PT and INR are ordered on a regular basis when a person is taking the drug warfarin to ensure that the prescription is working properly and that the PT/INR is appropriately prolonged. There is no set frequency for doing the test. A health practitioner will order them often enough to make sure that the drug is producing the desired effect - that it is increasing the person's clotting time to a therapeutic level without significant risk of excessive bleeding or bruising.
The PT may be ordered when a person who is not taking anticoagulant drugs has or of excessive bleeding or clotting, such as: PT, along with PTT, may be ordered prior to surgery when the surgery carries an increased risk of blood loss and/or when the person has a clinical history of bleeding, such as frequent or excessive nosebleeds and easy bruising, which may indicate the presence of a bleeding disorder.
^ Back to top What does the test result mean? For people taking warfarin, most laboratories report PT results that have been adjusted to the INR. These people should have an INR of 2.0 to 3.0 for basic "blood-thinning" needs. For some who have a high risk of a blood clot, the INR needs to be higher - about 2.5 to 3.5. The test result for a PT depends on the method used, with results measured in seconds and compared to the normal range established and maintained by the laboratory that performs the test.
This normal range represents an average value of healthy people who live in that area and will vary somewhat from lab to lab. Someone who is not taking warfarin would compare their PT test result to the normal range provided with the test result by the laboratory performing the test. A prolonged PT means that the blood is taking too long to form a clot. This may be caused by conditions such as liver disease, vitamin K deficiency, or a coagulation factor deficiency.
The PT result is often interpreted with that of the PTT in determining what condition may be present. Interpretation of PT and PTT in Patients with a Bleeding or Clotting Syndrome PT result ptt result Examples of conditions that may be present Prolonged Normal Liver disease, decreased vitamin K, decreased or defective factor VII, low-grade disseminated intravascular coagulation (DIC), anticoagulation drug (warfarin) therapy Normal Prolonged Decreased or defective factor VIII, IX, XI, or XII, von Willebrand disease (severe type), presence of lupus anticoagulant, autoantibody against a specific factor (e.
g., factor VIII) Prolonged Prolonged Decreased or defective factor I, II, V or X, severe liver disease, DIC, warfarin overdose Normal Normal or slightly prolonged May indicate normal ; however, PT and PTT can be normal in conditions such as mild deficiencies in coagulation factor(s) and mild form of von Willebrand disease. Further testing may be required to diagnose these conditions. ^ Back to top Is there anything else I should know? Some consumed substances, such as alcohol, can affect the PT and INR tests.
Some antibiotics can increase the PT and INR. Barbiturates, oral contraceptives and hormone-replacement therapy (HRT), and vitamin K (either in a multivitamin or liquid nutrition supplement) may decrease PT. Certain foods, such as beef and pork liver, green tea, broccoli, chickpeas, kale, turnip greens, and soybean products, contain large amounts of vitamin K and can alter PT results. It is important that a healthcare provider know about all of the drugs, supplements, and foods that a person has ingested recently so that the PT and INR results are interpreted and used correctly.
Some laboratories will report a PT as a percentage of normal, although this is not a common practice. ^ Back to top
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Atrial fibrillation patients are constantly at risk from blood clotting, strokes, or both. As a result, if you have atrial fibrillation there is a good chance that you’re either taking blood thinners now, or that you will be taking blood thinners someday. Most people will be working with the drug Warfarin, also known as the brand name Coumadin. Warfarin is a time-tested drug, but it comes with some challenges.
The biggest challenge of Warfarin is that you will have to monitor your blood. You do this through the PT-INR test (also known simply as the INR test). What is the PT-INR Test? PT is the abbreviation for “prothrombin time.” Prothrombin time is just a measure of how quickly your blood clots. INR is an abbreviation for “International Normalized Ratio.” This is the unit of measure that’s used to determine how quickly your blood is clotting.
So when you take the INR test, the doctor or the nurse will simply come and draw your blood. Then they’ll send your blood to a lab where they’ll add a blood clotting agent to your sample. They’ll then test the time that it takes for that blood to clot. There are also INR self-tests that you can take at home. You stick your finger, put the blood on a test strip, run the strip through the machine, and get your result.
Low numbers are good — 1 is the baseline for a perfectly healthy patient who is not on blood thinners of any kind. Higher numbers – 5 or higher – are dangerous. When your tests come back your doctor will help you make adjustments to your lifestyle and medication so that your INR stays within an optimal range. How Often Should You Take an INR Test? That depends. Some people only have to take the test once a month.
Some have to take a test every week. Usually weekly tests happen when you first start the therapy. This allows the doctor to adjust your medication. Once the doctor is satisfied he’ll typically move you to testing every four weeks. This is in part because the most trouble you’ll typically have stabilizing your INR levels will be at the very start of the therapy. Ranges can be all over the place at first, ranging from high to low and back again, but it usually stabilizes over time.
What You Should Know about Self-Testing Self-testing can be very beneficial. Just look at what ClotCare.com has to say about it: “In recent years, several studies have demonstrated that patient self testing leads to better care for patients on Warfarin. In 2011, the results of 22 such studies that included more than 8,000 patients found that self testing patients had a 42% lower risk of new blood clots, a 12% lower risk of major bleeding, and a 26% lower risk of death.
” These benefits are the result of better INR control. Self-testing also makes your life more convenient. It makes it easier for you to travel, reduces time away from your other commitments, and puts some power back in your hands. For example, you may be able to learn how to adjust your own dosages instead of having to consult with a physician every time. However, you should know that it can be expensive unless your insurance plan covers it.
And you do need a prescription for self-test devices…you can’t just pop into the drug store and buy one. Doctors will also generally want you to receive some training on the machine before they write that prescription. You should also know that most doctors won’t prescribe self-tests to you unless you’ve been a good, compliant patient in the past. So if you want this option, follow your doctor’s orders! Once you have the prescription you can buy your self-test machine.
Here is a list of the major manufacturers. Of course, if you’re not comfortable self-testing there is nothing wrong with continuing to take your tests at the clinic or at your doctor’s office! You should make the decision based upon what you feel will be best for your life and health.
Title: Test Inr At Home