Sarode Ravindra, Rawal Ajay, Lee Ray, Shen Yu-Min, Frenkel Eugene P
Department of Pathology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9073, USA.
Br J Haematol. 2006 Mar;132(5):604-7. doi: 10.1111/j.1365-2141.2005.05917.x.
Patients with a supratherapeutic international normalised ratio (ST-INR) are at risk for bleeding. ST-INR is corrected by withholding warfarin therapy and often by supplementing vitamin K or providing vitamin K-dependent factors; the exact therapeutic decision is based on the extent of the prolonged INR. Currently, ST-INRs are frequently observed in clinical practice due to the use of sensitive recombinant tissue thromboplastin reagents and automation. However, there are scant data correlating an ST-INR with various vitamin K-dependent factors. This prospective cohort study, set in a large tertiary care teaching hospital for the University of Texas Southwestern Medical Center at Dallas, defined the relationship between ST-INR (>5.0) and measured vitamin K-dependent procoagulant factors. Prothrombin time, INR and vitamin K-dependent factors II, VII, IX and X were measured in 78 patients with an INR > 5.0 (ST-INR) who were on warfarin therapy for more than 2 months. There was no significant relationship between the ST-INR and levels of important vitamin K-dependent factors II and X. These data support the recent guidelines that the management of an INR > 5.0 should be driven by the clinical determinants rather than specific INR values per se.
国际标准化比值高于治疗范围（ST-INR）的患者有出血风险。通过停用华法林治疗，通常还通过补充维生素K或提供维生素K依赖因子来纠正ST-INR；具体的治疗决策基于INR延长的程度。目前，由于使用敏感的重组组织凝血活酶试剂和自动化技术，临床实践中经常观察到ST-INR。然而，关于ST-INR与各种维生素K依赖因子之间关联的数据很少。这项前瞻性队列研究在达拉斯德克萨斯大学西南医学中心的一家大型三级护理教学医院进行，确定了ST-INR（>5.0）与所检测的维生素K依赖促凝血因子之间的关系。对78名接受华法林治疗超过2个月、INR>5.0（ST-INR）的患者测定了凝血酶原时间、INR以及维生素K依赖因子II、VII、IX和X。ST-INR与重要的维生素K依赖因子II和X的水平之间无显著关系。这些数据支持了最近的指南，即INR>5.0的管理应由临床决定因素而非INR具体值本身来驱动。
