A D Leonard | PubMed Health

PubMed1992

Cardioembolic stroke.

Approximately 15% of ischemic strokes are the result of an embolism from a cardiac source. Patients with nonvalvular atrial fibrillation, acute myocardial infarction, ventricular aneurysm, rheumatic heart disease, prosthetic heart valves and other less common cardiac disorders are at an increased risk for cardioembolic stroke. Clinicians must distinguish cardioembolic from atherosclerotic strokes to provide unique management for each patient. The nurse plays a dynamic role in diagnosis, education and treatment of patients at risk or who have had a stroke from a cardiac source. Knowledge of the pathophysiologic mechanisms and treatment options is essential for the nurse to adequately manage patient care.

Anticoagulants↗

PubMed1992

Reliance on prothrombin time ratios causes significant errors in anticoagulation therapy.

BACKGROUND: The intensity of warfarin anticoagulation in the United States may be inappropriate if the international normalized ratio (INR) is not used, or if the international sensitivity index (ISI) of the thromboplastin is outside the range of 2.2 to 2.6. METHODS: Fifty-three hospital laboratories provided data on the sensitivity of their thromboplastin and whether they reported INR values. Additional data on thromboplastin sensitivity were obtained from 140 laboratories involved in the Stroke Prevention in Atrial Fibrillation study. The three major manufacturers of thromboplastin confirmed the range of thromboplastin sensitivity reported by the laboratories. RESULTS: Of 53 laboratories surveyed, 16 (30%) could not provide ISI data and only 11 (21%) reported INR results. Unlabeled thromboplastin was being used by 20% to 24% of laboratories, and only 8% to 20% were using thromboplastins with an ISI of 2.2 to 2.6. At the time the three manufacturers were contacted, they reported marketing thromboplastins with ISI values from 1.2 to 2.8, but none of the thromboplastins at that time had ISI values between 2.2 and 2.6. CONCLUSION: Warfarin therapy in the United States is managed inappropriately because most laboratories do not report INRs and the variability in thromboplastin sensitivity produces misleading prothrombin time ratio results. Additionally, recent research may require reexamination if INR or ISI data were not provided.

Data Collection↗