The historical origins of modern international normalized ratio targets.
J Thromb Haemost
; 22(8): 2184-2194, 2024 Aug.
Article
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| MEDLINE
| ID: mdl-38795872
ABSTRACT
Prothrombin time (PT) and its derivative international normalized ratio (INR) are frequently ordered to assess the coagulation system. Plasma transfusion to treat incidentally abnormal PT/INR is a common practice with low biological plausibility and without credible evidence, yet INR targets appear in major clinical guidelines and account for the majority of plasma use at many institutions. In this article, we review the historical origins of INR targets. We recount historical milestones in the development of the PT, discovery of vitamin K antagonists (VKAs), motivation for INR standardization, and justification for INR targets in patients receiving VKA therapy. Next, we summarize evidence for INR testing to assess bleeding risk in patients not on VKA therapy and plasma transfusion for treating mildly abnormal INR to prevent bleeding in these patients. We conclude with a discussion of the parallels in misunderstanding of historic PT and present-day INR testing with lessons from the past that might help rationalize plasma transfusion in the future.
Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Tiempo de Protrombina
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Vitamina K
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Coagulación Sanguínea
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Relación Normalizada Internacional
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Hemorragia
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Anticoagulantes
Idioma:
En
Revista:
J Thromb Haemost
Asunto de la revista:
HEMATOLOGIA
Año:
2024
Tipo del documento:
Article