title: Quality indicators for critical international normalized ratio measurements in a hemostatic laboratory.
abstract: OBJECTIVE
  This study aimed at reviewing the quality indicators for reporting critical international normalized ratio (INR) in a coagulation laboratory.
  
  
  METHODS
  This is a retrospective study conducted at Aga Khan University Hospital, hemostatic laboratory from February 2010 till January 2011. Critical INR was defined as ≥5.0. All critical INRs were rechecked and results were communicated to the doctor or patient. Two quality indicators monitored were % of results communicated to the patient/doctor and % of results that remained critical after re-testing.
  
  
  RESULTS
  During the study period, a total of 59,980 INRs were reported. Of these 376 or 0.6% were critical. Successful communication of critical results to the doctor or patient was achieved in 275/376 (73.1%). Overall 353 or 94% (343 initial and 10 re-draw) samples had critical INR on repetition. Twenty five patients of the 240 warfarinized patients with critical INR had mild bleeding. No life threatening bleeding was observed in any patient.
  
  
  CONCLUSIONS
  We observed poor communication for notifying critical INR results during the study period. Routine repeat analysis of critical INR did not alter results in majority of samples. The study assisted in improving communication in subsequent years. Further work is needed to establish evidence based upper and lower cutoff of critical INR. Effect of replicate analysis on turnaround time and accuracy of results needs evaluation.
authors.affiliation: Section of Hematology, Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan. Electronic address: shabneez.haem@gmail.com.
authors.forename: Shabneez
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Section of Hematology, Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan. Electronic address: bushra.moiz@aku.edu.
authors.forename: Bushra
authors.initials: B
authors.lastname: Moiz
authors.affiliation: Coagulation, Clinical Laboratory, Section of Hematology, Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan. Electronic address: bushra.rizvi@aku.edu.
authors.forename: Bushra
authors.initials: B
authors.lastname: Afaq
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006490:Hemostatics; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods*; D007753:Laboratories / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006490:Hemostatics; D014859:Warfarin
keywords: Communication; Critical international normalized ratio; HAS-BLED score; Oral anticoagulants; Quality indicators; Turnaround time; Warfarin