- Selection of Thromboplastin from a variety of available/offered Thromboplastin reagents is very important as the therapeutic monitoring of Warfarin depends upon INR.
- Single most important criterion for selection of Thromboplastin is Thromboplastin reagent with value of ISI closer to 1.0
Impact of Thromboplastin with high ISI value
- Small change in PT would translate into a large change in INR
- Large change in degree of anticoagulation or coagulation factor deficiency
- So, when a small change in dose or physiology of patient occurs → Therapeutic intervention becomes necessary for physician
- Analysis becomes imprecise
- Coefficient of variation (CV) varies with the ISI value
- When the clinical decision is based on Target PT ratio, the range of PT ratio becomes small for any given value of INR
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