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Neurology

Neurology. APTT, PTT, PT, INR. The Tests We All Must Pass. Chronological Order of the Presentation Introduction APTT & PTT PT & INR Nursing Interventions Differences Current Research Summary Questions. The Cold Hard Facts. We all die, but first we must live

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Neurology

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  1. Neurology APTT, PTT, PT, INR

  2. The Tests We All Must Pass • Chronological Order of the Presentation • Introduction • APTT & PTT • PT & INR • Nursing Interventions • Differences • Current Research • Summary • Questions

  3. The Cold Hard Facts • We all die, but first we must live • We control our bodies via a large neurological system • Depriving this neurological system of blood flow = death • Thromboli can impede blood flow • Therefore thromboli = death

  4. The Selfish Gene • We all want to live • Keeping blood flowing to neurological system prolongs life • Thromboli impedes blood flow • Antithrombolitic therapy prevents thromboli formation • Therefore antithrombolitic therapy prolongs life

  5. Too Much of a Good Thing... • Too much antithrombolitic therapy = prolonged bleeding • Prolonged bleeding decreases blood flow to neurological system • Decreased blood flow to neurological system can cause death • Therefore too much antithrombolitic therapy can cause death

  6. How to Walk the Line • Develop tests to measure clotting factor • APTT & PTT • PT & INR

  7. APTT & PTT • APTT – Activated Partial Thromboplastin Time • PTT - Partial Thromboplastin Time • Use intrinsic factors to initiate coagulation pathways • Coagulation is timed and compared to a standard • Test used to diagnosis and monitor • 70 seconds…

  8. PT & INR • PT – Prothrombolin time • INR – International Normalization Ratio • Firm fibrin clot formation initiated by tissue thromboplastin (factor III) and calcium • Timed test

  9. PT & INR • Uses the equation: INR = (PTclient)x ISI PTavg * ISI - International Sensitivity Index * • INR = 1 • INR = 2-3 • INR = 2.5-3.5

  10. Nursing Interventions • Both are blood tests = similar interventions • Require interventions at all stages of the test: • Pre-test • Intra-test • Post-test

  11. Pre-Test • Education • Client Health History • Bleeding disorders • Surgeries, lab tests, diagnostic tests • Current and recent medications • Anticoagulants, acetylsalicylic acid, herbs, nutritional suppliments, and nutraceuticals

  12. Intra-Test • Follow directions • Breath normally • Avoid unnecessary movement • Identify client • Label vials accordingly • Fill tube completely • Have sample analyzed within 4 hours

  13. Post-Test • Observe venipuncture site • Provide instructions regarding excessive bleeding and bruising • Educate regarding prolonged APTT or high INR • Reinforce health care provider information or instructions • Notify client’s health care provider if INR < 2 or APTT < 53 seconds

  14. Where are the Differences • INR internationally recognized and understood • APTT uses kaolin, celite or elegia acid to speed up reaction time, therefore increasing the speed of the test • APTT not recommended for prophylactic low-dose heparin therapy • INR affected by more drugs • INR may be performed on samples older than 4 hours* * A topic of current research

  15. Current Research • Certified Diagnostic Plasmas for INR • Are 2.0-3.0 INR values optimal? • Obtaining INR and APTT values using different analyzers • INR self testing by clients

  16. Summary • APTT value < 70 seconds • INR value 2.0-3.0 • APTT and INR instrumental in anticoagulation therapies, should be monitored closely to ensure adequate dosing

  17. References • Cha, C.H., Park, C.J., Kim, D.H., Kim, M.J., Cho, Y.U., Jang, S. & Chi, H.S. (2010) Direct international normalized ratio determination using multicalibrators is more responsive than the conventional method for measuring prothrombin time. International Journal of Laboratory Hematology, 32(4), pp. 392–397. doi: 10.1111/j.1751-553X.2009.01195.x • Christensen, T.D., Jensen, C., Larsen T.B., Maegaard, M., Christiansen, K. & Sørensen, B. (2010) International normalized ratio (INR), coagulation factor activities and calibrated automated thrombin generation -- Influence of 24 h storage at ambient temperature. International Journal of Laboratory Hematology, 32(2), pp. 206-214. doi: 10.1111/j.1751-553X.2009.01170.x • Peng, L., Yan, C., Wu, X. & Nie, L. (2009) Comparability of the results of PT–INR with local MNPT and APTTR with MNAPTT on different coagulation analyzers in China. International Journal of Laboratory Hematology, 31(3), pp. 352-358. doi: 10.1111/j.1751-553X.2008.01071.x • Plesch, W. & van den Besselaar, A. M. H. P. (2009) Validation of the international normalized ratio (INR) in a new point-of-care system designed for home monitoring of oral anticoagulation therapy. International Journal of Laboratory Hematology, 31(1), pp. 20-25. doi: 10.1111/j.1751-553X.2007.00998.x

  18. References • You, J. H. S., Chan, F. W. H., Wong, R. S. M. & Cheng, G. (2005) Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intensity anticoagulation? British Journal of Clinical Pharmacology, 59(5), pp.582-587. doi: 10.1111/j.1365-2125.2005.02361.x

  19. Questions? • A wise person once observed: “Nurses are like the blood of the health care system...without them it would die.”

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