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MeSH Review

International Normalized Ratio

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Disease relevance of International Normalized Ratio


Psychiatry related information on International Normalized Ratio


High impact information on International Normalized Ratio

  • METHODS: In a multicenter, double-blind, randomized trial, we compared the effect of warfarin (at a dose adjusted to produce an international normalized ratio of 1.4 to 2.8) and that of aspirin (325 mg per day) on the combined primary end point of recurrent ischemic stroke or death from any cause within two years [9].
  • Of the 902 patients enrolled, 5 were later excluded because they had congenital protein C deficiency; 443 were randomly assigned to receive six weeks of oral anticoagulant therapy with a targeted international normalized ratio (INR) of 2.0 to 2.85, and 454 were randomly assigned to receive six months of such therapy [10].
  • Acetaminophen ingestion was independently associated in a dose-dependent manner with having an INR greater than 6.0 (P for trend <.001) [2].
  • The rate of events was similar between sexes, coumarin type, size of enrolling centre, and target INR [11].
  • These proteins were also found in the cell lines AR42J, BON, RIN, and INR [12].

Chemical compound and disease context of International Normalized Ratio


Biological context of International Normalized Ratio

  • To evaluate whether patients could be reliably monitored with a less intense regimen, we anticoagulated patients with warfarin for several months using a target INR range of 1.3 to 1.6 as determined by prothrombin time (PT) using a sensitive thromboplastin (Dade IS, International Sensitivity Index [ISI] = 1.3) [18].
  • Associations between a pharmacodynamic index (reduction in factor VII activity and international normalized ratio [INR] change) and several genetic polymorphisms (VKORC1: -4931T>C, -4451C>A, -2659G>C, -1877A>G, -1639G>A, 497C>G, 1173C>T, and CYP2C9*3) were investigated using haplotype and univariate analyses [19].
  • Analysis of transcriptional regulation of the alpha FR gene have revealed two promoter regions, P1 and P4, flanking exons 1 and 4, respectively, and a requirement for three SP1 sites and an INR element for optimal P4 activity [20].
  • During capecitabine treatment, the effect of warfarin on the baseline corrected AUC of the International Normalized Ratio (INR) increased by 2.8 times (90% CI, 1.33 to 5.70), with the maximum observed INR value almost doubling [21].
  • Reporter gene assays confirm that the region of the AM promoter containing the INR is the target of Myc-mediated repression [22].

Anatomical context of International Normalized Ratio


Associations of International Normalized Ratio with chemical compounds


Gene context of International Normalized Ratio

  • DESIGN AND METHODS: CYP2C9 genotyping was performed in 325 acenocoumarol-treated patients (INR target between 2.0 and 3.0) and in an additional group of 84 patients with repeated bleeding [33].
  • Dual promoters initiate hASH1 transcription, with the predominant site being an evolutionarily conserved initiator (INR) element [34].
  • We cloned the promoter region of the murine mac25 gene and found five repeats of CCAAT sequences, four Sp1 sites, a TATA-like sequence, and an initiator (INR) sequence [35].
  • By contrast, no significant changes were observed in CRP (2.2+/-0.7 vs. 1.7+/-0.7 mg/l), WCC (7.2+/-0.5 vs. 6.8+/-0.5 10(9) cells/l), APTR (0.91+/-0.02 vs. 0.93+/-0.02), INR (0.92+/-0.01 vs. 0.91+/-0.01), vWF (103+/-8 vs. 102+/-9 U/dl), and VIII:C (120+/-8 vs. 107+/-8 U/dl) levels [36].
  • Unexpectedly, we found relatively high levels of functional protein S in a group of patients on long-term warfarin therapy whose INR ranged from 1.1 to 3 [37].

Analytical, diagnostic and therapeutic context of International Normalized Ratio

  • Two large clinical trials have demonstrated that fixed-dose oral ximelagatran, 36 mg twice daily, administered without coagulation monitoring, prevents stroke and systemic embolic events in patients with nonvalvular AF as effectively as well-controlled, adjusted-dose warfarin (international normalized ratio 2.0 to 3.0) [38].
  • Length of stay in intensive care unit, postoperative hospital stay, laboratory results (bilirubin, INR, and LFTs), morbidity, and the different types of grafts in the 3 different periods were compared [39].
  • CONCLUSIONS: Older age itself and not as a marker for polypharmacy or increased number of medical conditions is associated with lower requirements for warfarin and a greater hemoglobin decrease postoperatively even when the proportion of time the INR fell within the therapeutic range is controlled [40].
  • METHODS: We randomly assigned 1279 patients 3 days after total hip replacement surgery to fixed-dose subcutaneous low-molecular-weight heparin (reviparin sodium, 4200 anti-Xa IU) or adjusted-dose oral anticoagulant (international normalized ratio, 2-3; acenocoumarol) for a 6-week period [41].
  • Design: Population-based cohort study in a sample of the Rotterdam Study. SUBJECTS: All patients who were treated with acenocoumarol or phenprocoumon in the study period from April 1, 1991 through December 31, 1998 and for whom INR data were available [42].


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  15. Comparison of bleeding in patients with nonvalvular atrial fibrillation treated with ximelagatran or warfarin: assessment of incidence, case-fatality rate, time course and sites of bleeding, and risk factors for bleeding. Douketis, J.D., Arneklev, K., Goldhaber, S.Z., Spandorfer, J., Halperin, F., Horrow, J. Arch. Intern. Med. (2006) [Pubmed]
  16. Drug interactions as a cause of overanticoagulation on phenprocoumon or acenocoumarol predominantly concern antibacterial drugs. Penning-van Beest, F.J., van Meegen, E., Rosendaal, F.R., Stricker, B.H. Clin. Pharmacol. Ther. (2001) [Pubmed]
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  20. The variant hepatocyte nuclear factor 1 activates the P1 promoter of the human alpha-folate receptor gene in ovarian carcinoma. Tomassetti, A., Mangiarotti, F., Mazzi, M., Sforzini, S., Miotti, S., Galmozzi, E., Elwood, P.C., Canevari, S. Cancer Res. (2003) [Pubmed]
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