Understanding Preanalytical Factors Affecting INR Results in Egyptian Patients on Maintenance Warfarin Therapy

• Published in: American journal of clinical pathology 2018-09, Vol.150 (suppl_1), p.S64-S64
• Main Authors: Shamma, Samir Nabhan, Farouk, Faten, Azzazy, Hassan
• Format: Article
• Language: English
• Subjects: Albumin; Anemia; Coagulation; Females; Hemoglobin; Males; Warfarin
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqy092.157

Abstract Introduction International normalized ratio (INR) is routinely monitored during warfarin (WRN) therapy. WRN response is affected by preanalytical variations, which may affect the accuracy of the assay, resulting in poor clinical management. Objective The aim of this study is to investigate the most common preanalytical variations that affect INR measurements in patients under warfarin maintenance therapy. Method INR was recorded in 106 patients under WRN maintenance therapy. Hemoglobin, PCV, and serum albumin were measured for all patients. Results There was significant differences in hemoglobin, PCV, and serum albumin between patients who reached their target INR (n = 56) and those who did not (n = 50). Among patients who did not achieve adequate coagulation, 42% suffered from severe anemia (7 males and 17 females) while 46.4% had low PCV (6 males and 20 females), and 40% had hypoalbuminemia (6 males and 14 females). Conclusions Low hemoglobin, PCV, and/or albumin levels were prevalent among patients who did not achieve their target INR values (n = 50). It is recommended to measure hemoglobin, PCV, and albumin levels in patients under WRN maintenance therapy who did not achieve their target INR values. Poor nutrition and health status as reflected by high prevalence of anemia or hypoalbuminemia may contribute to poor WRN coagulation control among Egyptians. Thus, monitoring anemia as well as albumin level may enhance the therapeutic effectiveness.