PT/INR/PTT info?coumadin/heparin-

[angell883RN]

Im having a problem getting this all straight and WHY it is? The highs,what they mean-the lows, etc-any simple explanations?

Thanx-I have to re read info each and every lab test! I just cant keep it straight and simple-

[lilylpn2008]

So- if one has a High ptt inr pt- then ones prone to clots? etc, potential stroke, etc? IF Im understanding at all!

To low-then bleeding potential is increased? (hence the no razors, vit K foods etc?)

Hi INR means blood is extremely thin, blood will take longer to coagulate any little cut an individual could bleed to death. example if inr is over 3.o i-e 9.0 n up. this person will need vit k either im or po stat. if inr is low below 2.0 u need coumadin the dr will decide the dose. hope this help.

[xtxrn, ASN, RN]

Hi INR means blood is extremely thin, blood will take longer to coagulate any little cut an individual could bleed to death. example if inr is over 3.o i-e 9.0 n up. this person will need vit k either im or po stat. if inr is low below 2.0 u need coumadin the dr will decide the dose. hope this help.

IMHO, and experience. :)

An INR of 3.0 is within some ranges of therapeutic, so would not require vit K.

I had vit K only when my INR was over 4.5 AND I had symptoms- otherwise it was managed with dose adjustments. When I asked about seriously risky levels, I was told that it became actually dangerous if above 8-10 (but depending on other symptoms, may be treated with something besides holding Coumadin for a day or so, or getting vit K)...

A little cut will not cause someone to bleed to death- but if someone is in an MVA, even with no apparent injuries, they need to be monitored- even if their levels are therapeutic. Larger wounds and lacerations could cause significant blood loss.

[dreamingofbeing]

In the department I work in the INR has to be less than 2 to do things like PICC lines, dialysis catheters, fistulograms, and a few other procedures. It has to be below 1.5 to do biopsies, any kind of fluid drainage, vertebroplasties, and bone marrow biopsies.

[nurseprnRN, BSN, RN]

back to clotting labs for a minute-- next time you have to remember this, think about why we care. we give people meds to make their blood make clots less easily.. why is that? right, so they don't grow clots in their fibrillating atria, or in their sluggish venous circulation, mostly.

so...how much do we not want them to clot? no clotting, never? no, probably not--- that gets soooo messy, and in the summer there are so many demands on the blood bank for transfusions. we try to be thrifty about that. we just want them to clot about half as well as normal. we want their clotting to take about twice as long as normal.

so... you want your clotting studies to be about twice normal. if normal is 1, then you want theirs about 1.5-2ish. if you are then going to send them to some other department for something that might make them encounter a sharp object, you want to be sure their clotting is a lot closer to normal (remember-- take pity on the blood bank). so someone going to gi lab (maybe because they have to have something big and pokey stuck down there/up there) should probably not go with a pro x (prothrombin time) of 1.7, because he'll bleed in a hard-to-reach place if they poke him too hard.

why do they give coumadin and heparin, anyway? don't people just bleed like stuck pigs c all that stuff on board? no, because they aren't additive.

think of the clotting cascade you learned about. i know, it's big and confusing and who can remember all those factors and stuff? i learned it four or five times and i still don't remember all of it. well, the hematology mavens can. all you need to remember is that heparin works fast, so that's why when people have to be anticoagulated in a hurry (like we just discovered they have a great big honking clot in their leg, or they just slipped in to atrial fibrillation), it's the gtt for them. but nobody goes home on heparin (and enoxaparin is soooo damned expensive), so people who need long-term anticoagulation are on warfarin (coumadin). but why?

well, short answer: heparin disables one part of the clotting cascade, enough to make the ptt rise to therapeutic levels (i always think the tt in ptt looks a little like an h, especially in my handwriting); it disables clotting that way. otoh, warfarin works on a totally different branch of the clotting cascade, enough to make the pro time rise to therapeutic levels (i remember the o in coumadin and the o in pro time); it disables clotting that way. but warfarin takes a little fooling around to get just the right dose.

so-- you heparinize somebody acutely (making a good 1.5-2x normal ptt) and meanwhile you have time fool around with the coumadin until you get the pro x just where it needs to be (and that is....? right, about 1.5- 2x normal). then you stop the heparin cuz you don't need it anymore, you don't need to wean it or anything; the coumadin has got the job in hand and is ready to take over.

hope this helps you see what's going on here, why we fool with it, and why if you remember 1.5-2x normal, you're right on all of it.

best book in the world for all this and so much more: laboratory and diagnostic tests with nursing implications, by joyce lefaver mckee. yer welcome.

[nerdtonurse?, BSN, RN]

Coumadin is warfarin -- it was actually used as rat poison until the 70's. Think "Kats kill Rats" -- vitamin K (K for Kat) is what's used to treat a high INR from too much coumadin.

Heparin has a "P" in it, and the antidote for excess heparin is protamine sulfate -- P and P.

Giving either coumadin or heparin drives UP the lab numbers, drives UP the likelihood the patient will bleed. If you go UP in the atmosphere, the air thins out. If you drive the INR or PTT UP, the blood's coagulation factors thin out.

If you give Vitamin K or Protamine, you drive DOWN the PTT or INR, and you drive DOWN the likelihood the patient will bleed.

And, FYI, if you give protamine, the patient's BP will drop like a rock.

[Altra, BSN, RN]

OK ... no one else but me find this to be an unusual question from a poster whose profile indicates 6 years of experience and certification in medical-surgical nursing?

[xtxrn, ASN, RN]

OK ... no one else but me find this to be an unusual question from a poster whose profile indicates 6 years of experience and certification in medical-surgical nursing?

Not necessarily :)- ER, psych, ortho, med-surg.....OK, in ER- some folks would have it on their med list- and labs drawn, but no longterm follow up to see patterns; psych- probably not a lot; ortho- some here and there, but depending on the shift, various exposure to labs & new orders; med-surg- some, but most people being started on Coumadin or Heparin would start out on a cardiac step-down or ICU setting....JMHO.....I saw the most Coumadin in nursing homes. By the time people on neuro were on Coumadin, they'd been on it only a few days, and the PTTs were most common with the heparin for TIAs and some CVAs. :)

I became MUCH more aware of the hassles of Coumadin when I was put on it. Nursing school and regular floor nursing is sort of 'cookbook' when it comes to anticoags.... JMHO

[mama_d, BSN, RN]

OK ... no one else but me find this to be an unusual question from a poster whose profile indicates 6 years of experience and certification in medical-surgical nursing?

Not really...at my hospital if you're in a condition where you need a hep gtt or Coumadin adjustments, you're most likely gonna be on a monitored floor. I thought it was crazy when we had pulled med-surg staff who were clueless about hep gtts, until she pointed out that we get them WAY more often...a fresh a-fib, new DVT or PE, new stroke, hx of mechanical valve, etc all would get placed on tele at least. The only reason why I retained info about such when I worked med-surg was b/c I sought out the information myself...where I was at, the attitude was that it was just up to the MDs to monitor the labs and adjust doses, and there was no reason for us mere nurses to get involved. (Looking back, it kinda scares me that there was that blase attitude!)

[NRSKarenRN, BSN, RN]

moved to our med savy forum see sticky at top can someone please explain inr & coumadin therapy to me?

[nurseprnRN, BSN, RN]

do not do not do not call anticoagulation medications "blood thinners," or talk about how your "blood is thinner." it makes patients confused because they think about, oh, thinning milk with water, or thinning paint with turpentine, and they can't relate that to bleeding and clotting...which is what they really need to understand when you teach them about black stools, easy bruising, and all that.