Prothrombin Time International Normalized Ratio

(PT INR)

₹360

This test is for

Male, Female

Test Preparation

A duly filled coagulation requisition form is mandatory for sample collection.
Overnight fasting is preferred.

Understanding Prothrombin Time International Normalized Ratio

What is Prothrombin Time International Normalized Ratio?

Prothrombin time (PT), is a test performed to estimate the ability of the plasma to clot. This test is used to diagnose bleeding disorders and also to check the efficacy of the ongoing anticoagulant medication. It is advised before undergoing any surgical procedure. The test assesses the functioning of blood coagulation factors I, II, V, VII, and X, and the time taken for conversion of prothrombin to thrombin.
The Prothrombin Time International Normalized Ratio PT(INR) is calculated from PT results and PT(INR) that is higher than normal indicates that blood will take a longer time to clot, while values shorter than normal could indicate a clotting disorder where blood takes lesser time to clot.

What is Prothrombin Time International Normalized Ratio used for?

· To detect and diagnose bleeding disorders or clotting disorders

· Before the surgical procedure

· To monitor the efficacy of treatment with anticoagulating medication, Warfarin

What does Prothrombin Time International Normalized Ratio measure?

The Prothrombin Time (PT) Test measures the ability of the plasma to clot in order to detect a bleeding disorder or clotting disorder and to monitor the effects of anticoagulant medication, Warfarin.

In case of any bleeding, the body responds to stop the blood loss as quickly as possible by forming a blood clot. This process of blood clotting or coagulation is called hemostasis and involves a series of chemical reactions in the blood (coagulation cascade) which activates blood proteins called coagulation factors one after another, in a series. The activated coagulation factors lead to the formation of fibrin mesh around the platelets and other blood cells at the site of bleeding and this complex hardens to form a “blood clot”.

Coagulation cascade proceeds by two pathways, the intrinsic pathway, and the extrinsic pathway. These pathways later merge together into a common pathway. Prothrombin (Coagulation Factor II) is converted to its active form thrombin in one of the reactions. The PT Test assesses the functioning of Blood Coagulation Factors I, II, V, VII, and X, which are parts of the extrinsic and common pathways by measuring the time taken for conversion of prothrombin to thrombin. The Activated Partial Thromboplastin Time (aPTT) Test measures the functioning of Blood coagulation Factors I, II, V, XII, VIII, IX, X, and XI, along with other factors Prekallikrein (PK), and High Molecular Weight Kininogen (HK) which form parts of the intrinsic and common coagulation pathways. The PT and aPTT tests are usually performed together and the results of both are evaluated simultaneously to determine the rate of blood clotting.

Warfarin is prescribed in the treatment of conditions caused or worsened by excessive blood clotting like Deep Vein Thrombosis (blood clot formation in blood vessels), irregular heartbeats, etc. The PT test is also performed to evaluate the effectiveness of Warfarin treatment. When performed to determine Warfarin efficacy, the result of the PT Test is expressed in terms of a measurement scale called the International Normalized Ratio (INR). Since the PT Tests are performed using different reagents in different labs giving rise to widely varying results in other conventional units, the INR system was created to maintain uniformity in the results.

Interpreting Prothrombin Time International Normalized Ratio results

Interpretations

Prothrombin time longer than the normal range indicates a bleeding disorder where blood takes a longer time to clot.

Prothrombin time shorter than the normal range indicates a clotting disorder where blood takes lesser time to clot.

The PT and aPTT tests are usually performed and evaluated simultaneously, and the results may be interpreted as follows:

PT RESULT	aPTT RESULT	CONDITIONS INDICATED
High	Normal	Liver diseases, Vitamin K deficiency, reduced activity of Factor VII, Disseminated Intravascular Coagulation (DIC), Warfarin treatment
Normal	High	Reduced activity of Factors VIII, IX, XI, or XII, Von Willebrand disease, autoantibodies destroying one or more coagulation factors
High	High	Reduced activity of Factors I, II, V or X, liver diseases, DIC, an overdose of Warfarin
Normal	Normal	Normal hemostasis usually. However, normal results may also appear in a mild reduction in coagulation factor activity and mild cases of Von Willebrand disease.

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about Prothrombin Time International Normalized Ratio

Frequently Asked Questions about Prothrombin Time International Normalized Ratio

Q. What factors can affect the PT test results?

The Prothrombin Time can be affected by a number of factors as follows: · Medications like oral contraceptives and barbiturates can reduce PT values · Vitamin K supplement in liquid or multivitamin forms reduce PT values · Hormone Replacement Therapy reduces PT values · Certain antibiotics like ciprofloxacin, azithromycin, levofloxacin, metronidazole, trimethoprim/sulfamethoxazole (TMP/SMX), fluconazole, and clarithromycin increase PT and INR values · Food items like beef, broccoli, chickpeas, soybean etc. can reduce PT values as they usually contain Vitamin K · Alcohol increases PT values

Q. What additional tests can be prescribed by your doctor in case of abnormal PT test result?

Additional tests that may be prescribed in case of abnormal Prothrombin Time test result are: · Platelet Count · Thrombin Time Test · Activated Partial Thromboplastin Time (aPTT) · Fibrinogen Test · Coagulation factor Tests · von Willebrand factor Test · Liver Function Test (LFT)

Q. What diseases can affect blood clotting to cause bleeding disorders?

Certain inherited conditions and diseases that can cause bleeding disorders include: · Hemophilia · Clotting factor deficiency · Vitamin K deficiency · Liver diseases · Bone marrow disorders · von Willebrand disease · Immune system diseases · Cancers like leukaemia

Q. What are some apparent symptoms of bleeding or clotting disorders?

Visible signs of bleeding or clotting disorders include: · Unexplained heavy bleeding · Abnormal menstrual bleeding in women · Bruising and bleeding easily · Frequent nosebleeds · Bleeding gums · Repeated heart attacks or strokes

Q. Is there any risk associated with this test?

There is no risk associated with the test. However, since this test involves a needle prick to withdraw the blood sample, in very rare cases, a patient may experience increased bleeding, hematoma formation (blood collection under the skin), bruising or infection at the site of needle prick.

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