INR, Protime, aPTT (coagulation tests) abnormal
Also Consider: Abnormal lab result
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INR/Protime
INR (International Normalized Ratio): measure of time it takes for the blood to clot compared to the normal time it should take.
Protime: actual time in seconds it takes for the blood to clot. It has been replaced by the INR and even though included on the laboratory report the result does not need to be reviewed if the INR is reported/reviewed.
Increased with warfarin anticoagulation, liver disease, severe illness, malabsorption, hemophilia, lab error
Used to manage warfarin therapy. Appropriate INR goals are either (2.0 to 3.0) or (2.5 to 3.5)
aPTT/PTT
Increased with heparin or warfarin anticoagulation, severe illness, hemophilia, liver disease, lab error
Used to manage heparin therapy.
Because lab error is common with these tests, consider repeating the test if unexpected results are received
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Fainting, dizziness or lightheadedness when standing up
Acute decline in ADL abilities
GI: Bleeding gums, rectal bleeding
GU: Heavy menstrual bleeding, blood in urine
Skin:; any new skin condition, i.e., bleeding, bruising, petechia, rash
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Immediately notify the medical staff & resident representative
INR greater than 10; or
INR greater than 5 with signs or symptoms of bleeding; or
aPTT greater than 110
Notify medical staff & resident representative within the next 16 hours.
INR increased by more than 0.4 in the last 1-2 days; or
INR above or below goal range; or
Abnormal INR or aPTT result in patient not receiving warfarin or anticoagulant therapy
Notify medical staff at the next regular rounds
Normal result in a patient not receiving warfarin therapy
SBAR Report
Situation: (Above goal range) (Below goal range) (Elevated) (INR Result) (aPTT result) "of ___" (associated with bleeding from ___ )
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
Reason the test was done
INR goal range if patient is on warfarin therapy.
Abnormal vital signs
Recent illness, antibiotics, medication changes
Symptoms and signs of bleeding, bruising, rash
Assessment: I am concerned about: __________
Recommendations/Requests:
Warfarin dose adjustment if INR out of range or increasing rapidly
Additional anticoagulation if INR is less than 1.8 and goal range is 2.5 to 3.5.
Date for repeat test
Oral Vitamin K 2.5mg - 5mg if INR is greater than 10.
Oral Vitamin K 1mg - 2mg if INR is greater than 5 and patient is at high risk of bleeding.
Parenteral Vitamin K solution can be given orally if smaller doses are needed.
Hospitalization if patient is bleeding
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor vital signs every 4-8 hrs for 2-3 days
Monitor for symptoms or signs of bleeding every 4-8 hours
Offer fluids frequently
Place on 24-hour report until INR at goal
Update care plan regarding bleeding risk
Review status and plan of care with designated representative
2025-04-27
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