From Vitamin K Antagonists to Liver International Normalized Ratio: A Historical Journey and Critical Perspective

Alexander Gatt; Dong Chen; Rajiv K. Pruthi; Patrick S. Kamath; Michael D. Leise; Aneel A. Ashrani; William L. Nichols; Rong He

doi:10.1055/s-0034-1395160

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2014; 40(08): 845-851
DOI: 10.1055/s-0034-1395160

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

From Vitamin K Antagonists to Liver International Normalized Ratio: A Historical Journey and Critical Perspective

Alexander Gatt

¹Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, Malta

,

Dong Chen

²Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota

,

Rajiv K. Pruthi

²Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota

,

Patrick S. Kamath

³Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota

,

Michael D. Leise

³Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota

,

Aneel A. Ashrani

²Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota

,

William L. Nichols

²Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota

,

Rong He

²Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota

› Author Affiliations

Abstract

Adoption of international normalized ratio (INR) to harmonize prothrombin time has greatly improved the safety and effectiveness of vitamin K antagonists (VKA) oral anticoagulant therapy. INR is also a major laboratory variable in calculating the widely used Model for End-Stage Liver Disease (MELD) score for liver transplant organ prioritization. However, since the conventional INR (INR_VKA) is calibrated specifically for VKA patients, its interlaboratory variation has a significant impact on the accuracy of MELD score. Though still requiring further clinical validation in large numbers of waitlisted patients, the alternative liver INR calibrated by using plasma from liver disease patients instead of VKA patients may harmonize the differences and thus more suitable for MELD score calculation. The objective of this article is to review the history of INR, MELD score, and liver INR, and discuss the challenges and solutions of liver INR implementation.

Keywords

prothrombin time - PT - INR - ISI - liver disease - warfarin - vitamin K antagonist - liver transplant - MELD score

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References

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