Reduced Risk of Death With Low INR

The higher a patient’s International Normalized Ratio (INR) value, the higher the risk of death, according to a study by researchers from the Hospital of Kungalv in Sweden. The INR is a measurement used in patients who are receiving oral anticoagulation therapy. The degree of anticoagulation is calculated from the prothrombin time (which measures the efficacy of the therapy) and is expressed as the INR.

The investigators analyzed 1.25 million INR measurements and the records of 42,451 patients receiving anticoagula-tion therapy at 46 clinics. Of those patients, 3,533 died. The mortality rate was lowest among patients with an INR of 2.2 to 2.3—regardless of the indication for anticoagulation treatment. However, 1,069 patients died within seven weeks after an INR of 3.0 or higher.
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The researchers estimated risk to be such that at least 500 deaths were associated with, but not necessarily caused by, a high INR. Not enough autopsies were performed to accurately determine the number of deaths that were caused by bleeding.

The researchers expected that bleeding would be the only cause of death that increased with increasing INR, but their analysis suggests that other causes predominated. A high INR has been reported to suggest a final stage of disease; malnutrition, diarrhea, and other factors probably influence the INR.