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Understanding coagulation monitoring

CoaguChek INRange

The importance of knowing your INR and keeping your level in check.

INR should be in a certain range. If it's too low, a recurrence of a blood clot can occur. If it's too low, it can lead to an elevated risk of bleeding.

- Dr. Bill Bartle, pharmacist

 

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Coagulation self-monitoring

Anticoagulation treatment.

 

Why are anticoagulants prescribed?

The human body has a complex mechanism called coagulation that causes blood to clot if a wound occurs. Under normal circumstances this is desirable; it allows the body to heal itself. Yet in some clinical conditions, coagulation can cause unwanted blood clots that may lead to complications and can be life threatening.

Oral anticoagulants, such as warfarin and phenprocoumon, are used to prevent blood clots and are often referred to as "blood thinners".

 

Anticoagulants are commonly prescribed for the following conditions:1-3

  • Stroke
  • Atrial fibrillation (irregular heartbeat)
  • Mechanical heart valves
  • Venous thromboembolism
  • Thrombophilia (tendency to cause blood clots)
  • Heart attack 

 

Monitoring your therapy.

What are INR values and why are they important? 

When prescribed anticoagulation therapy, such as the use of a vitamin K antagonist (VKA), taking the correct dose is crucial for effective treatment. The correct dose is established by measuring how long it takes your blood to clot. This is called the International Normalized Ratio (INR).

Keeping your INR in range is key. Know your value.

Regular INR monitoring is important to help determine if your dose needs to be adjusted. Your doctor will provide you with a target INR range. For people taking VKAs, which include warfarin, the target INR typically ranges from 2 to 3, but may be different depending on the patient and his or her condition.5-7

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Abbreviations

INR: International Normalized Ratio

 

  1. Ryan et al. (2008). J Clin Pharm Ther 33, 581-590
  2. Stevens et al. (2016). J Thromb Thombolysis 41, 154-164
  3. Lip et al (2002). BMJ 325, 1022-1025
  4. Wardrop amd Keeling. (2008). Br J Haem 141, 757–763
  5. Institute for Quality and Efficiency in Health Care (IQWiG). (2016). https://www.ncbi.nlm.nih.gov/books/NBK279434/#_NBK279434_pubdet_ [Accessed April 2019]
  6. Shikdar and Bhattacharya. (2018). Book available from: https://www.ncbi.nlm.nih.gov/books/NBK507707/#_NBK507707_pubdet_ [Accessed April 2019]
  7. Tidman et al. (2015). Aust Precr 38, 44-48
  8. American Heart Association. Available from: https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/a-patients-guide-to-taking-warfarin [Accessed April 2019]
  9. North American Thrombosis Forum. Available from: https://natfonline.org/2017/07/guide-inr-levels/ [Accessed April 2019]
  10. Ufer. (2005). Clin Pharmacokinet 44, 1227-1246