High PT, Low INR

akulahawkRN, ADN, RN, EMT-P · Oct 5, 2013

How is this possible?
PT: 12.9
INR: 1.24
Patient's entire life story located in my concept map thread

One of the references I just looked up indicates that the PT is at the high end of normal and the INR is just a little elevated. Could be the local lab?

Stephalump · Oct 5, 2013

I have the norm for PT as 9.3-11.3 and INR as 1.5-3.0 at this particular lab. I'm trying to figure out is this person is at risk for bleeding or embolism since she has hepatitis AND antiphospholipid antibody syndrome, and the labs aren't helping. :eek:

allnurses Guide · Oct 5, 2013

Lab is wnl/slightly elevated. The patient may have slight risk of bleeding, but the risk of embolism would be decreased not increased. http://www.pathology.vcu.edu/clinical/coag/PT%20INR.pdf Normal INR would be around 1.0 unless they are some type of therapeutic intervention i.e. coumadin.

]"The normal INR is typically 0.9 to about 1.1. On warfarin therapy, the INR elevates to between 2 and 3.5 and most hospital pharmacies and clinical hematology services will have specific INR goals documented in their treatment protocols." http://www.aacc.org/members/nacb/NACBBlog/lists/posts/post.aspx?ID=98

shaas, ASN, RN · Oct 5, 2013

Both values are WNL. Due to the hypercoagulable state (because of the pt.'s APLS), you need to first check if these lab values are within the targeted therapeutic ranges for whatever anticoagulation therapy the pt. is on. If lower than therapeutic range, then she's at risk for clotting (DVT and, if left to embolize, PE), not necessarily bleeding. If the dosage is high, and the labs are significantly elevated outside the therapeutic ranges, then the pt. is at risk for bleeding.

Addendum: Just read your pt. hx. Hepatitis also elevates the pt.'s risk for coagulation. Liver is responsible for many things, among which is protein synthesis (coagulation factors are proteins) as well as the vitamin K synthesis. You also need adequate serum Ca2+ to coagulate effectively.

I think that your instructor would be satisfied with either the risk for bleeding (simply because pt. is on anticoagulation therapy) or the risk for ineffective tissue perfusion (having liver and renal diseases really put pt. at risk for impaired circulation and perfusion). If it were in med school, I'd definitely side with the latter possibility (85%) than the bleeding risk (15%).

KelRN215, BSN, RN · Oct 5, 2013

I have the norm for PT as 9.3-11.3 and INR as 1.5-3.0 at this particular lab. I'm trying to figure out is this person is at risk for bleeding or embolism since she has hepatitis AND antiphospholipid antibody syndrome, and the labs aren't helping.

Normal INR is 1. The range you quote is the range you'd look for in an anticoagulated patient.