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«Safe at the finish line» – I'm sure of it!

  • timer  5.5 Minutes to read
  • 21 December 2021
  • Written by Axonlab Österreich
  • Hospital

A plaster helps to cover a bleeding spot. However, our usually well-functioning clotting system is responsible for stopping the bleeding. An intact blood clotting system ensures wound closure of internal and external wounds. The blood vessel contracts at the injured site, blood platelets accumulate at the affected site of the vessel wall, clump together and a «plug» is formed. Result: first wound closure.

The clotting factors are activated and ensure the stabilisation and fixation of the thrombus through the formation of fibrin.

 

Racing around the edge of the table, bumped into, «small bruise» – forgotten tomorrow.

By hitting an edge, blood vessels are injured, blood penetrates the tissue, clots under the skin and a «bruise», a haematoma, is visible. Until it disappears, different colours show until the degradation process is complete and everything is quickly forgotten. The coagulation system has worked.If the processes run in this way after the events, we can speak of a functioning coagulation system and show this by an INR-measurement:

The INR value! -> is about 1.0

 

It's not that easy for everyone.

If the blood coagulates too little, the most common form of coagulation disorder, there is a risk of excessive bleeding and thus excessive blood loss. If clotting is excessive, there is a great risk of thrombosis, a vessel occlusion by blood clots.

 

In any case, we are talking about potentially life-threatening events.

In the case of congenital or acquired diseases such as atrial fibrillation / cardiac arrhythmias, recurrent thromboses, embolisms, heart attacks, the use of artificial heart valves or cardiovascular support systems («artificial heart»), regular coagulation monitoring with appropriate medication is indispensable. For a long time, we associated coagulation values with the «Quick value». Since the 1980s, the International Normalised Ratio = INR has been considered the standardisation of the Quick value. Initiated by the WHO to standardise PTZ measurement according to internationally valid guidelines.

The INR is calculated from the thromboplastin time (TPZ) of the patient's plasma divided by the TPZ of a normal plasma exponentiated by the «International Sensitivity Index» (ISI). This is the factor that relates the sensitivity of the TPZ reagent to an international standard.

In patients who are treated with anticoagulant drugs from the group of vitamin K antagonists, oral anticoagulants such as Marcumar®, the INR determination with a POCT system can provide regular information about the status of coagulation.

Depending on the diagnosis, a certain target range is specified in which the patient is considered to be "safely" adjusted:

Prevention of thrombosis                           INR 1.5 to 2.5

Pulmonary embolism, atrial fibrillation   INR 2 to 3

mechanical heart valves between            INR 2.5 to 3.5

 

Nevertheless, each patient must be considered individually and the medication must be adjusted accordingly!

The INR is subject to fluctuations caused by diet, sport, stress (negative or positive), food supplements and many other factors. Close INR monitoring provides reliable and short-term information so that the medication can be adjusted quickly. INR measurements - for the «safety» of the patient are usually carried out in the doctor's practice.  However, there is also the possibility of being a «self-manager». Under certain conditions, patients on long-term or continuous vitamin K antagonist therapy can learn to determine their INR and dose themselves*.

In addition to the will to assume personal responsibility, successful patient self-management naturally always requires close coordination with the attending physician.

*Studies, such as that of C. Heneghan et al. in The Lancet, 2012, demonstrate the reduced complications and at the same time a positive «Time-in-Therapeutic-Range» (TTR) in PSM.

CONCLUSIONS:

Even the smallest injury activates our clotting cascade.

It is IMPORTANT to be as safe as possible in the target area. I am sure about that.

 

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