Dear Dominik,
The maximum value I saw after an overdose of warfarin was 62 (it was a
case-report at a thrombosis congress). But generally it is below 20. I
don't know specific reference.
Silvy
Khaled Nm schrieb:
Dear nmusers,
I am looking for a reference for a maximum value for INR, byeond this
value the drug toxicity of anticoagulatnt may occur.
thanks for any response
Abduljalil
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Dear Abduljalil,
If only it were as simple as that!
The major toxicity of anticoagulation is bleeding. However bleeding
episodes may even occur at normal INR levels (much more factors are
involved). There is no "secure" level, below which no bleeding occurs,
but the risk of bleeding gradually increases when the INR increases.
The risk of bleeding we are willing to accept (i.e. the maximum INR value)
is given by the probability and seriousness of expected thromboembolic
events (risk benefit ratio). Therefore target INR values are fixed
dependent on the underlying disease: E.g. venous thromboembolic disease:
2.5, artificial heart valves: 2.5-3, thrombophilia: 3.
With respect to non-bleeding toxicity of coumarins: these are largely
dose independent.
Regards Dominik
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Prof. Dr. med. Dominik Uehlinger
Klinik und Poliklinik für Nephrologie und Hypertonie
Universität Bern, 3010 Bern - Inselspital
Tel. +41 31 632 31 44, Fax +41 31 632 97 34
[EMAIL PROTECTED]
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