How Israeli Physicians Manage Patients with Elevated INR Values: A Descriptive Study from Primary Care

Patients on long-term anticoagulation therapy sometimes develop international normalized ratio (INR) values above the recommended optimal range of 2-5 (1,2). This increases the risk of spontaneous bleeding (1) and thus requires regulation to restore it to the normal therapeutic range. This by either temporarily stopping the anticoagulant treatment or by reducing the dosage (3). Sometimes it may also be advisable to administer Vitamin K (3,4). If the patient is not referred to hospital then a decision about which intervention to adopt is invariably left in the hands of the patient’s personal physician. However, the optimal strategy in such circumstances is presently underpinned more by ‘expert opinion’ (1,2,4,5) than by evidence-based studies.
We investigated a group of anticoagulated Israeli patients with elevated INR levels to determine how they were actually treated by their primary care physicians.