# What is the meaning of inr?

If you are anything like me, you probably think that INR stands for “I’m Not Really” sure what it means. But boy oh boy, would we both be wrong! In reality, INR has a much more interesting and important meaning (not really).

## So…What is it?

INR actually stands for International Normalized Ratio. Woah there! That sounds fancy as heck- but what does it mean? Essentially, when someone’s blood is not clotting properly, they may need to take a medication called Warfarin to thin their blood out. The amount of Warfarin needed can vary from person to person, which makes tracking dosage tricky.

To ensure proper dosages when taking warfarin (itself an anticoagulant aka ‘blood thinner’), healthcare professionals use the test that yields international normalized ratio (INR) scores in patients who are being treated with blood-thinning medications.

The test results help doctors determine if someone’s dose needs adjusting by measuring how quickly their blood clots compared to standard values.

### Where did this come from?

So now that we know what INR actually means let’s delve into some background information about where it came from (because obviously our curiosity hasn’t died yet) . Back in 1983 two guys named Rosendaal and Cannegieter developed the concept of an International Normalized Ratio because at the time people were using different tests all over Europe – which was making things difficult between countries (as if dealing with language barriers wasn’t enough) .

Their aim was simply to create consistency so everyone could get on board with managing Warfarin doses effectively.

## How do you measure/Calculate It?

### Let’s talk numbers

(brace yourselves my friends), I’m about list off some technical terms

When calculating one’s International Normalized Ratio score or ‘INR score’, doctors will take measurements relating to prothrombin time (PT)

(Let’s break that down further)

Prothrombin, aka Factor II, is a protein found in blood that the liver produces. When there’s an injury or tissue damage causing bleeding, Prothrombin[1] conversion takes place through the help of different proteins and vitamins [such as vitamin K]. It then becomes thrombin which helps to form fibrinogen into fibrin (the stuff essential for clotting) . Once we know how long it takes one’s blood to clot by measuring PT—this measurement usually involved taking a small amount of blood – this can be analyzed using special testing devices.

### The Math

Now here comes everything you actually need to know..I swear! With all those numbers taken from your test results, they throw them into a formula giving you your final number known as an INR[2].

The actual formula itself is:

INR = [(Measured PT/Geometric Mean Normal PT) ^ International Sensitivity Index(ISI)]

## What does it mean?

So now that we’ve gotten all technical up in here (honestly where did I go wrong with my life choices? Then again if grade school math told us anything—it’s that these things are about patterns) Let’s explore what our trusty Inr scores really tell us!

Healthier Blood

A person without a Warfarin treatment plan should have an INR sitting between 0.8-1.2 . While someone being treated with Warfarin would aim for something between 2-3 , sometimes higher depending upon factors such as previous clots. So essentially having even slightly elevated levels indicates healthier and safer-to-not-get-a-clot-so-kidding-around-isnt-an-option-here kind of-blood.

Be sure though not use any other anticoagulant medication or treatments such as aspirin when your INR score rises to unhealthy levels.

### What does it mean for Warfarin treatment?

If someone’s PT values ​​increase, this means the blood is taking longer than usual to clot (which can lead to a risk of bleeding). Conversely, if it decreases then becomes thicker which increases clotting potential—in these cases ,the doctor may increase the warfarin dosage given in order bring back an ideal target range.

## Why do we even need INR scores anyway?

Surely there are easier ways?! But actually that’s not necessarily true. Simply measuring how long it takes for one’s blood to clot (PT), without doing further steps toward determining their International Normalized Ratio, leaves room for margin of error due sample non-comparability between different patients and healthcare centers who aren’t sharing standard normal values [3]. By using an international normalized ratio (INR) system worldwide, doctors achieve more accurate results across all cases; preventing under – or over-coagulation situations from arising.

It probably goes without saying– but let’s just say it …Anticoagulants weaken the body’s natural ability to form clots when injuries occur,[4] They literally block some protein factors protecting our coagulation process by interfering with their production cycle [5]. Let’s look at the table below (I know I said I wouldn’t have over 10 rows in tables..but well..you try explaining enzyme-inscripted proteins without them) :

Factors Affected by factor
Factor II Prothrombin
Factor VII Converts proenzyme (inactive version) VHep(vitamin K Hydroxylase)
Factor IX Conversion changes inactive proteins X->Xa
Factor X Active when converted to Xa by IX and VII enzymes

In cases of Warfarin intake, both Factors II and VII are affected. This is where everyday consumption of healthy foods rich in vitamin K would play a huge role [6]; Its responsible for producing majority of clotting proteins within our liver but no worries encouraged daily doses should differ per person taking warfarin depending on each patient’s INR score needed

## The Side Effects

– Bruising
– Bleeding from gums or nose – this often occurs spontaneously
– Black tarry stools / blood in urine
– Severe anxiety

### It’s Not the Endgame

Making sure your dosage schedule stays regular with healthcare professionals advice helps minimise the risk for bleeding problems such as hemorrhages.

Always let doctors know when any unusual discomfort arises especially those indicative you’re under/over prescribed.

While at the beginning we may have thought that Inr was just another confusing medical term (the worst kind there is!), now we know that understanding it means managing anticoagulant dosing more efficiently leading to healthier outcomes.
Whether you’re being treated with “blood thinning” medication like Warfarin or are simply curious, knowing your INR levels can be like exploring new data-driven insights about yourself (or.. well..just give you an excuse for breaking out coffee ice cream) .

So go ahead—keep sharing ‘Nerd’ facts until everyone views us inside-out yet insightful!

Remember folks—we maybe confused most days—but today won’t be one of them!

References:

1) Prothrombin & Fibrinogen [https://www.nlm.nih.gov/cgi/mesh/2019/cgibyterm?&field=entry&exact=A03.055.715]

2) INR formula [https://www.acc.org/latest-in-cardiology/articles/2019/05/15/13/52/introduction-to-the-international-normalized-ratio-incorporating-student-presentation]

3) Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 14th edition

4) Anticoagulants..vaguely-explained-language[https://medlineplus.gov/druginfo/natural/patient-warfarin.html#footer-1]

5)Warfarin Mechanisms of Action: Where Are We Now? [DOI:

10.1080 / 17474124.2020 .1713418]

6)Vitamin K Rich Foods You Can’t Ignore With Warfarin Medication Use [https://scrc.bioanalyticsinc.com/en/vitamin-k-rich-foods-cant-ignore-warfarin-medication-use/

8)[ https://patient.info/news-and-features/warfarins-side-effects-someone-has-to-speak-out]