does TPN make INR to increase or decrease?

[unsaint77]

I thought INR would increase since platelet would be more diluted by TPN. But I want to make sure. thanks.

[AgentBeast, BSN, RN]

TPN has no direct effect on INR.

[Nurse SMS, MSN, RN]

TPN does not affect INR.

[unsaint77]

Thanks for the comments. Would TPN have any effect on clotting time one way or the other?

[AgentBeast, BSN, RN]

Thanks for the comments. Would TPN have any effect on clotting time one way or the other?

Generally no.

[Double-Helix, BSN, RN]

Thanks for the comments. Would TPN have any effect on clotting time one way or the other?

Not unless your TPN contains heparin.

Think about the composition of TPN. What ingredients are in there? Generally, you'll find dextrose, proteins, electrolytes, trace elements, and lipids (which may be mixed with TPN or given separately)

Do any of those ingredients have an effect on INR or clotting time?

[mindlor]

I thought INR would increase since platelet would be more diluted by TPN. But I want to make sure. thanks.

One way TPN could affect clotting is if it contains vitamin K which is the antidote for coumadin. Too much vit K would negate the coumadin and increase clotting and decrease bleeding time. So someone on anticoagulation therapy would need to watch that vit K......

[Double-Helix, BSN, RN]

One way TPN could affect clotting is if it contains vitamin K which is the antidote for coumadin. Too much vit K would negate the coumadin and increase clotting and decrease bleeding time. So someone on anticoagulation therapy would need to watch that vit K......

Correct. Which is exactly the reason why Vitamin K is NOT routinely included in TPN preparations, but given separately if it's deemed the patient is Vitamin K deficient.

[psu_213, BSN, RN]

I thought INR would increase since platelet would be more diluted by TPN. But I want to make sure. thanks.

Try to avoid the idea that higher INR means that the blood is "thinner." If the INR is elevated, it means the blood will take longer to clot. This is based on one step of the clotting cascade. It is not a reflection on the viscosity of the blood, nor is it directly related to platelet count.

[nurseprnRN, BSN, RN]

see, this is exactly it, psu_213. good for you for seeing that. if i had a dime for every time i read that anticoagulants were "blood thinners," i could have retired long since.

please, everyone, do not use the term "blood thinners," because it makes patients think of water in the milk or turpentine in the paint (or perhaps fewer platelets per cc). anticoagulants do not thin the blood, they decrease its clotting ability. i know you will hear other nurses and even doctors use this term speaking to patients because they think "anticoagulant" is a big scary/confusing word. they are wrong to do so. i've heard people say that they are always cold when they take warfarin because they have thin blood. obviously not the case, so someone has missed the boat on patient teaching and this resulted in confusion they tried to avoid.

think about your patient teaching: if you are teaching someone about his anticoagulant medications, how do you reinforce the idea of why he takes them if he thinks it has to do with thinning blood and not making clots?

"your heartbeat is irregular, atrial fibrillation, and that increases the chances that a blood clot will form in your heart. (or, "you have a tendency to form clots in the deep veins in your leg. these could travel to your heart and lungs and be dangerous.") so we give you this medication to decrease your clotting. we test your blood every x days/weeks/months to see that the dose is still correct, by looking at how long your blood takes to clot. while you are taking this medication, called an "anticoagulant," your blood will not clot as fast as normal, so you should avoid things that might result in injury like ..... you should look out for easy bruising or bleeding, or bleeding that doesn't stop, black in your bms or if you vomit blood; tell your healthcare provider right away."

is that so hard? get in the habit of doing it right in the first place and you won't have to change your language later.

[KelRN215, BSN, RN]

I thought INR would increase since platelet would be more diluted by TPN. But I want to make sure. thanks.

INR (international normalized ratio) is a measurement of prothrombin time expressed in a ratio that is normalized internationally (since different countries use different systems and have different normal values). Prothrombin time is a measure of how quickly the blood clots and is related to plasma clotting factors, not platelet count. If a patient has a high PT/PTT (too high for surgery), what do you do to remedy that? If you have to transfuse blood products, you transfuse FFP, not platelets as their platelet count could be perfectly normal.

[hmccue, BSN]

Do you mean tPA (the clot buster)?