Melih YÜKSEL, Suna ERAYBAR, Halil KAYA, Mehmet Oğuzhan AY

Yüksek INR Düzeylerine Rağmen Görülen İki İskemik İnme Olgusu

Warfarin, dünya çapında tromboembolik vakaların tedavisinde ve önlenmesinde yaygın olarak kullanılan bir K vitamini antagonistidir. Terapötik aralığı dardır ve bunu uluslararası normalleştirilmiş oran (INR) ile takip edilir. Düşük INR seviyelerinde iskemik durumlar gözlenirken, daha yüksek INR seviyelerinde kanama görülür. Varfarin kullanan 45 yaşında kadın ve 79 yaşında erkek hasta nörolojik defisit ile acil servise başvurdu. Her iki hastada da radyolojik görüntüleme ile iskemik inme saptandı. Ancak INR düzeyleri laboratuvar testlerinde (11.44 ve 12.37 kU/L) anlamlı olarak daha yüksekti. Bu kadar yüksek INR seviyelerinde normal olarak kanama beklenmesine rağmen iskemik inme meydana geldi. Literatürde yayınlanan birçok çalışmanın aksine bu olgu sunumu sonuçları açısından ilginç bilgiler ortaya koymuştur.

Anahtar Kelimeler:

İskemik inme, Yüksek INR seviyeleri, Warfarin doz aşımı, Acil Tıp

Two Ischemic Stroke Cases Accuring Despite High INR Levels

Warfarin is a vitamin K antagonist commonly used in the treatment and prevention of thromboembolic cases worldwide. Its therapeutic range is narrow and is followed by the international normalized ratio (INR). Ischemic conditions are observed at low INR levels whereas bleeding is seen at higher INR levels. A 45-year-old woman and a 79-year-old man using warfarin were admitted to the emergency department with a neurological deficit. Ischemic stroke was revealed via radiological imaging in both patients. However, INR levels were significantly higher in laboratory tests (11.44 and 12.37 kU / L).Ischemic stroke occurred although bleeding is normally expected at such high INR levels. Contrary to many studies published in the literature, this case report revealed interesting information in terms of its conclusions.

Keywords:

İschemic stroke, Hıgh INR levels, Warfarine overdose, Emergency Medicine,

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