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      Estandarización del índice internacional normalizado en pacientes pre-quirúrgicos del Hospital San Juan de Dios de Cuenca Translated title: Standarization of the Internacional Normalized Index in pre-surgical patients at Hospital San Juan de Dios of Cuenca Translated title: Padronização do Índice Normalizado Internacional em pacientes pré-cirúrgicos do Hospital San Juan de Dios em Cuenca

      research-article
      Vive Revista de Salud
      CET-BOLIVIA
      INR, ISI, Coagulation, Prothrombin time, INR, INR, ISI, Coagulação, Tempo de protrombina, INR, ISI, Coagulación, Tiempo de protrombina

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          Abstract

          RESUMEN El índice internacional normalizado (INR, por sus siglas en inglés), es un tipo de cálculo matemático que se basa en las pruebas de tiempo de protrombina. La seguridad y eficacia de la terapia dependen del efecto anticoagulante que reciban dentro del margen terapéutico fijado por el médico en base al estudio de sus tiempos de coagulación, específicamente expresado como el intervalo de INR. Establecer los rangos de referencia del INR aplicado en resultados obtenidos en pacientes del sexo masculino y femenino en edades entre los 18 hasta 60 años de edad en el Hospital San Juan de Dios de Cuenca, durante los meses de enero a junio del año 2021. Los datos fueron recopilados de 699 pacientes que acudieron a consulta externa del Hospital San Juan de Dios de Cuenca del área de hematología, que incluyen valores de tiempo de tromboplastina y su referente INR en base al ISI establecido en el reactivo emitido por el fabricante. Se establecieron los valores normales de INR los cuales varían en referencia al sexo del paciente. Para el sexo masculino valores con límite inferior 0,82 y límite superior 1,16; para el sexo femenino con límite inferior de 0,51 y el límite superior de 1,51. Los valores de INR tienen variaciones de acuerdo al sexo siendo los valores de hombres mas altos en relación al de las mujeres en el rango inferiores, Evidentemente los factores influyentes van en relación del sexo, edad, dieta y sobretodo la genética del paciente.

          Translated abstract

          ABSTRACT The International Normalized Ratio (INR) is a type of mathematical calculation based on prothrombin time testing. The safety and efficacy of therapy depend on the anticoagulant effect they receive within the therapeutic range set by the physician based on the study of their clotting times, specifically expressed as the INR range. To establish the reference ranges of the INR applied in results obtained in male and female patients between 18 and 60 years of age at the San Juan de Dios Hospital in Cuenca, during the months of January to June 2021. The data were collected from 699 patients who attended the outpatient clinic of the Hospital San Juan de Dios de Cuenca in the hematology area, including thromboplastin time values and their INR referent based on the ISI established in the reagent issued by the manufacturer. Normal INR values were established, which vary according to the patient's sex. For the male sex values with a lower limit of 0.82 and an upper limit of 1.16; for the female sex with a lower limit of 0.51 and an upper limit of 1.51. The INR values vary according to sex, with the values for men being higher in relation to those for women in the lower range. Evidently, the influencing factors are related to sex, age, diet and above all the patient's genetics.

          Translated abstract

          RESUMO A Relação Internacional Normalizada (INR) é um tipo de cálculo matemático baseado em testes de tempo de protrombina. A segurança e eficácia da terapia depende do efeito anticoagulante que recebem dentro da faixa terapêutica estabelecida pelo médico com base no estudo de seus tempos de coagulação, expressa especificamente como a faixa INR. Estabelecer as faixas de referência do INR aplicadas em resultados obtidos em pacientes do sexo masculino e feminino com idade entre 18 e 60 anos no Hospital San Juan de Dios em Cuenca, durante os meses de janeiro a junho de 2021. Os dados foram coletados de 699 pacientes que compareceram ao ambulatório do Hospital San Juan de Dios de Cuenca na área de hematologia, incluindo os valores de tempo de tromboplastina e sua referência INR baseada no ISI estabelecido no reagente emitido pelo fabricante. Foram estabelecidos valores normais de INR, que variam de acordo com o sexo do paciente. Para o sexo masculino, com um limite inferior de 0,82 e um limite superior de 1,16; para o sexo feminino, com um limite inferior de 0,51 e um limite superior de 1,51. Os valores de INR variam de acordo com o sexo, sendo os valores para os homens maiores em relação àqueles para as mulheres na faixa inferior. Evidentemente, os fatores de influência estão relacionados ao sexo, idade, dieta e, acima de tudo, à genética do paciente.

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          Most cited references27

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          Standardization of Prothrombin Time/International Normalized Ratio (PT/INR).

          The prothrombin time (PT) represents the most commonly used coagulation test in clinical laboratories. The PT is mathematically converted to the international normalized ratio (INR) for use in monitoring anticoagulant therapy with vitamin K antagonists such as warfarin in order to provide test results that are adjusted for thromboplastin and instrument used. The INR is created using two major PT 'correction factors', namely the mean normal PT (MNPT) and the international sensitivity index (ISI). Manufacturers of reagents and coagulometers have made some efforts to harmonizing INRs, for example, by tailoring reagents to specific coagulometers and provide associated ISI values. Thus, two types of ISIs may be generated, with one being a 'general' or 'generic' ISI and others being reagent/coagulometer-specific ISI values. Although these play a crucial role in improving INR results between laboratories, these laboratories reported INR values are known to still differ, even when laboratories use the same thromboplastin reagent and coagulometer. Moreover, ISI values for a specific thromboplastin can vary among different models of coagulometers from a manufacturer using the same method for clot identification. All these factors can be sources of error for INR reporting, which in turn can significantly affect patient management. In this narrative review, we provide some guidance to appropriate ISI verification/validation, which may help decrease the variability in cross laboratory reporting of INRs.
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            The international normalized ratio. A guide to understanding and correcting its problems.

            With the increasing use of the international normalized ratio (INR) to monitor warfarin therapy, a number of problems with prothrombin time (PT) testing have been identified that have led some laboratory physicians to question the reliability of the INR. This is ironic, because it was the introduction of the INR system that brought to light some of the long-standing problems with the technique of PT monitoring. However, these problems are not insurmountable if a compromise can be reached between the expectations of laboratory physicians and of clinicians. Thus, the laboratory physician seeks a perfect assay system, which in the case of the INR is unattainable at present, because of differences in PT reagents and methods. In contrast, the clinician is satisfied with a system of monitoring that provides safe and effective warfarin dosing. This goal can be achieved provided that certain details of PT testing are observed. In this communication, which is directed to practicing clinicians, the potential problems with the INR system are discussed, their clinical relevance is critically reviewed, and solutions are offered.
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              Pruebas de coagulación

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                Author and article information

                Journal
                vrs
                Vive Revista de Salud
                Vive Rev. Salud
                CET-BOLIVIA (La Paz, , Bolivia )
                2664-3243
                April 2022
                : 5
                : 13
                : 179-190
                Affiliations
                [1] orgname
                Article
                S2664-32432022000100179 S2664-3243(22)00501300179
                10.33996/revistavive.v5i13.140
                c84b9fc1-59a8-4591-bb81-9ce26bf065fa

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 16 February 2022
                : 28 February 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 12
                Product

                SciELO Bolivia


                Coagulação,Prothrombin time,Coagulation,ISI,Tiempo de protrombina,Coagulación,INR,Tempo de protrombina

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