Transcript
Page 1: History of the Prothrombin Time and Development of the INR

History of the Prothrombin Time and Development of the INR

Leon Poller

European Concerted Action on Anticoagulation

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Mean results with different thromboplastins in 30 patients

Poller L. Acta Haemat. 32:292-298 (1964)

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Mean doses of warfarin from different geographical locations.

Striped boxes indicate rabbit reagent.

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Bleeding events with Simplastin (ISI 2.5) and Manchester Reagent (ISI 1.0) control.

Hull et al (1982). Prothrombin Ratio 2.0 Simplastin = 4.7 INR.

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Figure 1 Figure 2

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ACCP Consensus Meeting

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An example of the orthogonal regression line

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Calibration lines from the seventeen participant centres

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The hierarchical structure of thromboplastin calibration

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IRP = International Reference Preparation. *Now discontinued.

IRR = International Reference Reagent. IS = International Standard.

International reference preparations for thromboplastins 2003

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INR = Prothrombin Ratio (PR)ISI

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Causes of Erroneous INRs (1)

• Pretest variablesErroneous prothrombin ratio determination

Variations in manual techniqueCoagulometer effects

• Incorrect normal value due to: Failure to use MNPT Error in MNPT due to: (a)   unrepresentative selection; (b)   technical faults; (c)   non-use of geometric mean.

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Causes of Erroneous INRs (2)

• Incorrect ISI calibration • Drift of ISI • Poor distribution of coumarin test samples,

inadequate numbers of test samples• Incorrect choice of IRP • Incorrect transformation of PR to INR

• ‘Rogue’ plasmas (outliers)

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Errors in PT Determination • Pretest variables • blood collection • citrate • container • storage time • temperature • evacuated and non-evaculated tubes • variations in manual technique • coagulometers The overall trend of coagulometers is to accelerate the normal PT

with the PR distorted.System-related ISI of limited value.

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Coagulometer Effects of ACL and MLA

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The ISI of thromboplastins and effect of ISI on the width of therapeutic range in prothrombin ratios.

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Percentage deviation of mean INR from the IRP value with various thromboplastin reagents during the

induction phase

Reagent C

Reagent B

Reagent A

Reagent D

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Reliability of monitor INR on CoaguChek Mini and TAS PT-NC at 10

centres

No. of samples

Displayed INR

“true” INR

% difference

Mean displayed

INR difference

TAS PT-NC 536 2.91 2.52 +15.2

21.3

CoaguChek Mini

536 2.40 2.59 -7.1

Br Med J 2003;327:30-34

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DAILY TELEGRAPH 23 SEPTEMBER 2003

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Proportion of time in INR ranges

*INR results for all weeks, including first 3 weeks

Lancet 1998;352:1505-9


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