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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Wednesday, October 26, 2016

Improper Use of INR

ACEP Now - By Radecki R - October 9, 2016
"There are many overused tests in the vastness of medicine, but few synthesize both overuse and inappropriateness like the international normalized ratio (INR). The INR is a test with a singular purpose: a standardized calibration for the measurement of the anticoagulant activity of warfarin. It has no other reason for existence, yet it is frequently ordered as part of routine screening for previously undiagnosed coagulopathy. Indeed, its use is so prevalent as a stowaway in anachronistic order sets that ACEP once considered tracking coagulation studies as a marker of low-quality care. The INR and its related cousin prothrombin time (PT) are elevated only in a handful of conditions: vitamin K–dependent factor deficiency, presence of factor VII inhibitor, disseminated intravascular coagulation, or in the setting of massive transfusion. An incidentally encountered mild elevation of INR or PT is typically of no clinical significance nor is it associated with increased bleeding risk...
  • The INR does not accurately reflect underlying coagulopathy
  • FFP should not routinely be used as procedural prophylaxis or treatment for the bleeding cirrhotic with an elevated INR..."