Review article: the prothrombin time test as a measure of bleeding risk and prognosis in liver disease
Open Access
- 11 May 2007
- journal article
- review article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 26 (2), 141-148
- https://doi.org/10.1111/j.1365-2036.2007.03369.x
Abstract
Background Prothrombin time (PT)‐derived international normalized ratio (INR) is used to assess bleeding risk and prognosis in cirrhosis, and to guide management of associated coagulation disturbances. Recent studies cast doubt on the validity of the assumptions that form the basis for these applications. Aims To review and critique the use of the PT‐INR in cirrhosis. Methods Search of the literature. Results In cirrhosis, there is a decrease in both pro‐ and anti‐coagulants. The PT‐INR measures only the activity of procoagulants and fails to capture changes in anticoagulants. It is therefore not surprising that the PT does not predict the bleeding risk. The PT‐INR provides a robust measure of liver function but recent data showed INR inter‐laboratory variability in this setting. This is not surprising as the INR was validated to normalize results for patients on vitamin‐K antagonists, not for cirrhosis. This limitation was not appreciated, but the INR is used to construct the model for end‐stage liver disease score to prioritize patients for liver transplantation. Reports showed that model for end‐stage liver disease is modified by the thromboplastin used for testing. Conclusions Alternate tests to predict bleeding risk should be developed. The potential for misuse of the PT‐INR should drive the development of alternate algorithms for organ allocation.Keywords
This publication has 44 references indexed in Scilit:
- The international normalized ratio calibrated for cirrhosis (INRliver) normalizes prothrombin time results for model for end-stage liver disease calculationHepatology, 2007
- Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation testsHepatology, 2005
- Oral Anticoagulant Monitoring by Laboratory or Near-Patient Testing: What a Clinician Should Be Aware OfSeminars in Vascular Medicine, 2003
- Assessment of blood coagulation in severe liver disease using thromboelastographyBlood Coagulation & Fibrinolysis, 2003
- Prothrombin time in liver failure: Time, ratio, activity percentage, or international normalized ratioHepatology, 1996
- Variation between centers in technique and guidelines for liver biopsyLiver International, 1996
- Liver biopsy bleeding time: An unpredictable eventJournal of Gastroenterology and Hepatology, 1994
- Hemostasis and fibrinolysis in severe liver failure and their relation to hemorrhageHepatology, 1986
- Bleeding after liver biopsy does not correlate with indices of peripheral coagulationDigestive Diseases and Sciences, 1981
- Transection of the oesophagus for bleeding oesophageal varicesBritish Journal of Surgery, 1973