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Re: INR value

From: Dominik Uehlinger <uehlinger>
Date: Tue, 21 Oct 2008 16:23:02 +0200

Khaled Nm schrieb:
> Dear nmusers,
> I am looking for a reference for a maximum value for INR, byeond this
> value the drug toxicity of anticoagulatnt may occur.
> thanks for any response
> Abduljalil
> __________________________________________________
> Do You Yahoo!?
> Tired of spam? Yahoo! Mail has the best spam protection around
Dear Abduljalil,

If only it were as simple as that!

The major toxicity of anticoagulation is bleeding. However bleeding
episodes may even occur at normal INR levels (much more factors are
involved). There is no "secure" level, below which no bleeding occurs,
but the risk of bleeding gradually increases when the INR increases.

The risk of bleeding we are willing to accept (i.e. the maximum INR
value) is given by the probability and seriousness of expected
thromboembolic events (risk benefit ratio). Therefore target INR values
are fixed dependent on the underlying disease: E.g. venous
thromboembolic disease: 2.5, artificial heart valves: 2.5-3,
thrombophilia: 3.

With respect to non-bleeding toxicity of coumarins: these are largely
dose independent.

Regards Dominik

Prof. Dr. med. Dominik Uehlinger
Klinik und Poliklinik für Nephrologie und Hypertonie
Universität Bern, 3010 Bern - Inselspital
Tel. +41 31 632 31 44, Fax +41 31 632 97 34
Received on Tue Oct 21 2008 - 10:23:02 EDT

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