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Prothrombin Time and International Normalized Ratio (PT/INR)

Also Known As: PT, Pro Time, Prot ime, INR

T his art icle was last reviewed on February 20, 2019. T his art icle was last modifi ed on March 23, 2021.

At a Glance

Why Get Tested?

A prot hrombin t ime (PT) is a t est used t o help det ect and diagnose a bleeding disorder or excessive
clot t ing disorder; t he int ernat ional normalized rat io (INR) is calculat ed from a PT result and is used t o
monit or how well t he blood-t hinning medicat ion (ant icoagulant ) warfarin (Coumadin®) is working t o
prevent blood clot s.

When To Get Tested?

When you are t aking warfarin or when you have unexplained or prolonged bleeding or inappropriat e blood
clot t ing

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A blood sample drawn from a vein; somet imes blood from a fingerst ick

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 Test Preparation Needed?

None needed, alt hough if you are receiving ant icoagulant t herapy, t he blood sample should be collect ed
before t aking your daily dose.

What is being t est ed?

The prot hrombin t ime (PT) is a t est t hat helps evaluat e your abilit y t o appropriat ely form blood clot s. The
int ernat ional normalized rat io or INR is a calculat ion based on result s of a PT t hat is used t o monit or
individuals who are being t reat ed wit h t he blood-t hinning medicat ion (ant icoagulant ) warfarin (Coumadin®).

A PT measures t he number of seconds it t akes for a clot t o form in your sample of blood aft er subst ances
(reagent s) are added. The PT is oft en performed along wit h a part ial t hromboplast in t ime (PTT) and
t oget her t hey assess t he amount and funct ion of prot eins called coagulat ion fact ors t hat are an import ant
part of proper blood clot format ion.

In t he body, when t here is an injury and bleeding occurs, t he clot t ing process called hemost asis begins. This
process involves in part a series of sequent ial chemical react ions called t he coagulat ion cascade, in which
coagulat ion or "clot t ing" fact ors are act ivat ed one aft er anot her and result in t he format ion of a clot . There
must be a sufficient quant it y of each coagulat ion fact or, and each must funct ion properly, in order for normal
clot t ing t o occur. Too lit t le can lead t o excessive bleeding; t oo much may lead t o excessive clot t ing.

In a t est t ube during a laborat ory t est , t here are t wo "pat hways" t hat can init iat e clot t ing, t he so-called
ext rinsic and int rinsic pat hways. Bot h of t hese t hen merge int o a common pat hway t o complet e t he clot t ing
process.

The PT t est evaluat es how well all of t he coagulat ion fact ors in t he ext rinsic and common pat hways of
t he coagulat ion cascade work t oget her. Included are: fact ors I (Fibrinogen), II (Prot hrombin), V, VII and X.
The PT/INR may be done at t he same t ime as a PTT, which evaluat es t he clot t ing fact ors t hat are part
of t he int rinsic and common pat hways: XII, XI, IX, VIII, X, V, II (prot hrombin), and I (fibrinogen) as well as
prekallikrein (PK) and high molecular weight kininogen (HK).

The PT and PTT evaluat e t he overall abilit y t o produce a clot in a reasonable amount of t ime and, if any of
t hese fact ors are deficient in quant it y or not funct ioning properly, t he t est result s will be prolonged.
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wit hin t he same laborat ory over t ime, t he normal ranges also will fluct uat e. To st andardize result s across
different laborat ories in t he U.S. and t he world, a World Healt h Organizat ion (WHO) commit t ee developed
Order Your Test
and recommended t he use of t he Internationalized Normalized Ratio (INR), calculat ed based on t he PT
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t est result , for people who are receiving t he ant icoagulant warfarin (Coumadin®). Warfarin is prescribed for
people wit h a variet y of condit ions, such as deep vein t hrombosis (DVT) and some cardiovascular diseases
(CVD) like at rial fibrillat ion t o "t hin" t heir blood and prevent inappropriat e clot t ing.

The INR is a calculat ion t hat adjust s for changes in t he PT reagent s and allows for result s from different
laborat ories t o be compared. Most laborat ories report bot h PT and INR values whenever a PT t est is
performed. The INR should be only applicable, however, for t hose t aking t he blood-t hinning medicat ion
warfarin.

Common Quest ions

How is t he t est used?

The prot hrombin t ime (PT) is used, oft en along wit h a part ial t hromboplast in t ime (PTT), t o help
diagnose t he cause of unexplained bleeding or inappropriat e blood clot s. The int ernat ional normalized
rat io (INR) is a calculat ion based on result s of a PT and is used t o monit or individuals who are being
t reat ed wit h t he blood-t hinning medicat ion (ant icoagulant ) warfarin (Coumadin®).

The PT and INR are used t o monit or t he effect iveness of t he ant icoagulant warfarin. Warfarin is
prescribed for people wit h a variet y of condit ions t o "t hin" t heir blood and prevent inappropriat e
clot t ing. A healt hcare pract it ioner will t ypically prescribe warfarin and measure how well t hat dose
"t hins" t he blood using t he PT/INR. The dose may be adjust ed up or down depending on t he result and
t o ensure t he dose is sufficient in prevent ing clot s wit hout causing excessive bleeding. This balance
requires careful monit oring.

Warfarin may be prescribed for condit ions such as:

Irregular heart beat (at rial fibrillat ion)

The presence of art ificial heart valves
Deep vein t hrombosis (DVT), pulmonary embolism (PE)
Ant iphospholipid syndrome
Occasionally, in heart at t acks wit h cert ain risk fact ors

The PT test may be used along wit h a PTT as t he st art ing point s for invest igat ing excessive bleeding
or clot t ing disorders. By evaluat ing t he result s of t he PT and PTT t oget her, a healt h pract it ioner can
ORDER YOUR GET TESTED AT A GET be
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Examples of ot her t est ing t hat may be done along wit h a PT and PTT or in follow up t o abnormal
result s include: Order Your Test
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 Plat elet count – t o det ermine if plat elet s are decreased, which can cause excessive bleeding
Fibrinogen t est ing – may be done t o rule out a low level or dysfunct ion of fibrinogen as a cause of a
prolonged PT
Coagulat ion fact or t est s – t hese measure t he act ivit y (funct ion) of coagulat ion fact ors. They can
det ect reduced levels of t he prot ein or prot eins t hat don't work properly (have reduced funct ion).
Rarely, t he ant igen level (quant it y) of a coagulat ion fact or may also be measured.
von Willebrand fact or – somet imes ordered t o help det ermine if von Willebrand disease is t he cause
of a prolonged PTT
Lupus ant icoagulant t est ing – may be ordered t o furt her invest igat e t he cause of prolongat ion of
PTT and/or PT, part icularly for pat ient s wit h clot t ing disorders

Based on carefully obt ained pat ient hist ories, t he PTT and PT t est s are somet imes select ively
performed as pre-surgical or before ot her invasive procedures t o screen for pot ent ial bleeding
t endencies.

When is it ordered?

A PT and INR are ordered on a regular basis when a person is t aking t he ant icoagulant drug warfarin t o
make sure t hat t he drug is producing t he desired effect .

The PT may be ordered when a person who is not t aking ant icoagulant drugs has signs or sympt oms of
excessive bleeding or clot t ing, such as:

Unexplained bleeding or easy bruising

Nosebleeds
Bleeding gums
A blood clot in a vein or art ery
An acut e condit ion such as disseminat ed int ravascular coagulat ion (DIC) t hat may cause bot h
bleeding and clot t ing as coagulat ion fact ors are used up at a rapid rat e
A chronic condit ion such as severe liver disease t hat may affect hemost asis

PT, along wit h PTT, may be ordered prior t o surgery when t he surgery carries an increased risk of blood
loss and/or when t he person has a clinical hist ory of bleeding, such as frequent or excessive
nosebleeds and easy bruising, which may indicat e t he presence of a bleeding disorder.

ORDER YOUR GET TESTED AT A GET YOUR

1What does t he t est
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For people t aking warfarin, most laborat ories report PT result s t hat have been adjust ed t o t he INR.
These people should have an INR of 2.0 t o 3.0 for basic "blood-t hinning" needs. For some who have a
high risk of a blood clot , t he INR needs t o be higher - about 2.5 t o 3.5.

For individuals who are not t aking warfarin, t he reference range for a PT depends on t he met hod used,
wit h result s measured in seconds and compared t o t he normal range est ablished and maint ained by t he
laborat ory t hat performs t he t est . This normal range represent s an average value of healt hy people
who live in t hat area and will vary somewhat from lab t o lab. Someone who is not t aking warfarin would
compare t heir PT t est result t o t he normal range provided wit h t he t est result by t he laborat ory
performing t he t est .

A prolonged PT means t hat t he blood is t aking t oo long t o form a clot . This may be caused by
condit ions such as liver disease, vit amin K deficiency, or a coagulat ion fact or deficiency (e.g., fact or VII
deficiency). The PT result is oft en int erpret ed wit h t hat of t he PTT in det ermining what condit ion may
be present .

Interpretation of PT and PTT in Patients with a Bleeding or

Clotting Syndrome

PT PTT
EXAMPLE OF CONDITIONS THAT MAY BE PRESENT
RESULT RESULT

Liver disease, vit amin K insufficiency, decreased or defect ive fact or VII,
Prolonged Normal chronic low-grade disseminat ed int ravascular coagulat ion (DIC),
ant icoagulat ion drug (warfarin) t herapy

Decreased or defect ive fact or VIII, IX, XI, or XII, von Willebrand disease
Normal Prolonged (severe t ype), presence of lupus ant icoagulant , aut oant ibody against a
specific fact or (e.g., fact or VIII)

Decreased or defect ive fact or I, II, V or X, severe liver disease, acut e DIC,
Prolonged Prolonged
warfarin overdose

May indicat e normal hemost asis; however, PT and PTT can be normal in
Normal or
condit ions such as mild deficiencies in coagulat ion fact or(s), mild form of
Normal slight ly
von Willebrand disease, and presence of weak lupus ant icoagulant .
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Can I do t his t est at home? Order Your Test

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Yes, if you will be t aking warfarin for an ext ended period of t ime. The Food and Drug Administ rat ion has
approved several home PT and INR t est ing syst ems. However, home t est ing is usually done in t he
cont ext of a home-based coagulat ion management program t hat involves pat ient t raining and defined
response and management prot ocols. For more det ails, see t he art icle on Home Test ing.

What food and medicat ions can affect PT and INR result s?

Some ant ibiot ics can increase t he PT and INR. Barbit urat es, oral cont racept ives and hormone-
replacement t herapy (HRT), and vit amin K (eit her in a mult ivit amin or liquid nut rit ion supplement ) may
decrease PT.

Drinking alcohol can also affect PT result s. Cert ain foods, such as beef and pork liver, green t ea,
broccoli, chickpeas, kale, t urnip greens, and soybean product s, cont ain large amount s of vit amin K and
can alt er PT result s. It is import ant t hat a healt hcare provider knows about all of t he drugs,
supplement s, and foods t hat you have consumed recent ly so t hat t he PT and INR result s are
int erpret ed and used correct ly.

I am being t reat ed wit h warfarin (Coumadin®). Should I avoid eat ing foods t hat are
rich in vit amin K and will limit ing t hese foods cause an increased risk of vit amin K
deficiency?

Warfarin works by reducing t he available vit amin K for t he liver t o make several of t he blood clot t ing
fact ors. Thus, warfarin and vit amin K are ant agonist s—t hey work against each ot her. Significant
increases or decreases in t he amount of vit amin K a person consumes can affect how well t hat
person's dose of warfarin works in prevent ing blood clot s wit hout causing excess bleeding. So rat her
t han avoiding foods rich in vit amin K, it is more import ant for you t o consume a consist ent amount of
t hose foods each day. You can get t he vit amin K you need as long as you are consist ent about t he
amount you consume.

Should I have a PT done at t he same t ime of day?

It isORDER
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you t o have your blood rechecked wit hin a few days t o judge t he effect of t he dosage change on your
PT/INR (it is not an immediat e effect ).
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 My PT/INR result s vary somet imes, yet my doctor doesn’t change my prescript ion.
Why?

Illness, change in diet , and some medicat ions (as ment ioned above) can alt er PT/INR result s. Cert ain
foods, such as beef and pork liver, green t ea, broccoli, chickpeas, kale, t urnip greens, and soybean
product s cont ain large amount s of vit amin K and can alt er PT/INR result s. The blood collect ion
t echnique and t he difficult y in obt aining t he blood sample can also affect t est result s. If your
healt hcare provider has concerns about t he st abilit y of your PT/INR, your provider may t est your blood
more frequent ly before adjust ing your dose.

Healt h Professionals – LOINC

LOINC Observat ion Ident ifiers Names and Codes (LOINC®) is t he int ernat ional st andard
for ident ifying healt h measurement s, observat ions, and document s. It provides a common
language t o unambiguously ident ify t hings you can measure or observe t hat enables t he
exchange and aggregat ion of clinical result s for care delivery, out comes management , and research. Learn
More.

Listed in the table below are the LOINC with links to the LOINC detail pages. Please not e when you click
on t he hyperlinked code, you are leaving Lab Test s Online and accessing Loinc.org.

LOINC LOINC DISPLAY NAME

52129-4 INR post heparin adsorpt ion Coag (PPP) [Relat ive t ime]

34714-6 INR Coag (Bld) [Relat ive t ime]

46418-0 INR Coag (BldC) [Relat ive t ime]

38875-1 INR Coag (Plat elet poor plasma or blood) [Relat ive t ime]

6301-6 INR Coag (PPP) [Relat ive t ime]

5964-2 PT Coag (Bld) [Time]

ORDER YOUR
46417-2 GET TESTED
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Coag (PPP cont rol) [Time]
cho o se f ro m
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42638-7 PT Coagulat ion 1:1 saline (PPP) [Time]

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 LOINC LOINC DISPLAY NAME

5902-2 PT Coag (PPP) [Time]

Relat ed Cont ent

On This Site
Tests:
Act ivat ed Clot t ing Time (ACT)
Part ial Thromboplast in Time (PTT, aPTT)
Fibrinogen
Coagulat ion Fact ors
Plat elet Count
Plat elet Funct ion Test s
Warfarin Sensit ivit y Test ing

Conditions:
Bleeding Disorders
Excessive Clot t ing Disorders
Vit amin K Deficiency
Liver Disease
Disseminat ed Int ravascular Coagulat ion (DIC)
Deep Vein Thrombosis (DVT)

In the News:
FDA Issues Safet y Alert s for Some At -Home Test s (June 17, 2019. )
Inaccurat e Result s from INR Met ers Prompt New Informat ion from FDA (April 6, 2018. )

Elsewhere On The Web

American Societ y of Hemat ology: Bleeding Disorders
American Societ y of Hemat ology: Blood Clot s
MedlinePlus Medical Encyclopedia: Bleeding disorders
ORDER YOURh.gov: Bleeding
Womenshealt GET TESTED
disordersAT Afact sheet GET YOUR

1 TEST
MedlinePlus: 2 LOCAL LAB
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Nat ional Blood Clot Alliance

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View Sources
Sources Used in Current Review

Prot hrombin Time Test . Mayo Clinic. Available online at ht t ps://www.mayoclinic.org/t est s-
procedures/prot hrombin-t ime/about /pac-20384661. Accessed on 9/18/18.

Prot hrombin Time (PT) Test . Cleveland Clinic. Available online at

ht t ps://my.clevelandclinic.org/healt h/diagnost ics/17691-prot hrombin-t ime-pt -t est /t est -det ails. Accessed
on 9/18/18.

Prot hrombin Time, Plasma. Mayo Medical Laborat ories. Available online at
ht t ps://www.mayomedicallaborat ories.com/t est -cat alog/Clinical+and+Int erpret ive/40934. Accessed on
9/19/18.

Prot hrombin Time (PT). MedlinePlus. Available online at ht t ps://medlineplus.gov/ency/art icle/003652.ht m.

Accessed on 9/19/18.

(November 21, 2014) Prot hrombin Time. Medscape. Available online at

ht t ps://emedicine.medscape.com/art icle/2086058-overview. Accessed on 10/3/18.

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PA [18t h Edit ion].

Pagana, Kat hleen D. & Pagana, Timot hy J. (2001). Mosby's Diagnost ic and Laborat ory Test Reference 5t h
Edit ion: Mosby, Inc., Saint Louis, MO.

(2001). Int ernat ional Normalized Rat io (INR). Universit y Pat hology Consort ium [On-line handbook]. Available
online at ht t p://www.medicine.uiowa.edu/pat h_ handbook/upcmd/01025/inr.ht ml.

(2000-2004) INR. Nort hwest Cardiovascular Associat es, S.C. [On-line informat ion]. Available online at
ht t p://www.nwcardio.com.

Brose, M. (2003 June 1). Prot hrombin t ime (PT). MedlinePlus Medical Encyclopedia [On-line informat ion].
Available online at ht t p://www.nlm.nih.gov/medlineplus/ency/art icle/003652.ht m

Brooke Huffman, G. (2001 April 15). Management of Pat ient s Taking Warfarin. American Family Physician,
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Tips from
TESTot her Journals [On-line journal]. Available online at ht tSENT
p://www.aafp.org/afp/20010415/t
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1 Online o r over
t he pho ne
2 LOCAL LAB
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cho o se f ro m
3
RESULTS
DIRECTLY TO
YOU PoweredINR.
by HealthT estingCenters.com
Walling, A. (2003 February 15). Opt imal Ant icoagulat ion: Det ermining t he Safest American Family
Physician, Tips from ot her Journals [On-line journal]. Available online at
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ht t p://www.aafp.org/afp/20030215/t ips/22.ht ml. Your Test
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Miller, K (2003 Sept ember 15). Warfarin Management wit h Mild Elevat ion of INR. American Family Physician,
Tips from ot her Journals [On-line journal]. Available online at ht t p://www.aafp.org/afp/20030915/t ips/6.ht ml.

Sadovsky, R. (2002 February 15). Fact ors Affect ing t he Delay in Ret urn of Therapeut ic INR Level. American
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Hort on, J. and Bushwick, B. (1999 February 1). Warfarin Therapy: Evolving St rat egies in Ant icoagulat ion.
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Henry's Clinical Diagnosis and Management by Laborat ory Met hods. 21st ed. McPherson R, Pincus M, eds.
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Pagana K, Pagana T. Mosby's Manual of Diagnost ic and Laborat ory Test s. 3rd Edit ion, St . Louis: Mosby
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Levin, M. (Updat ed March 9, 2007) Prot hrombin Time (PT). MedlinePlus Encyclopedia. Available online at
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(Updat ed May 29, 2007) Prot hrombin Time. Massachuset t s General Hospit al, Pat hology Service. Available
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(June 2008) Ansell J, et al. Pharmacology and management of t he vit amin K ant agonist s: American College
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ht t p://www.heart rhyt hmfoundat ion.org/a-fib/INR_ FINAL.pdf. Accessed August 2008.

Universit y of Alabama at Birmingham Coagulat ion Service. Bleeding Guidelines. Available online at
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Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnost ic and Laborat ory Test Reference 10t h Edit ion:
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Clarke, W., Edit or (© 2011). Cont emporary Pract ice in Clinical Chemist ry 2nd Edit ion: AACC Press, Washingt on,
DC. Pp 265-281.
ORDER YOUR GET TESTED AT A GET YOUR
Brooks, M. (2012 February LOCAL
3). Close INR Monit oring Needed When Warfarin Users Add an Ant ibiot ic.
1 TEST
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t he pho ne
2 LAB
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RESULTS
Medscape Today News from Reut ers Healt h InformatDIRECTLY
cho o se f ro m
SENT Order Your Test
TO informat ion]. Available online at
ion [On-line
YOU Powered by HealthT estingCenters.com
ht t p://www.medscape.com/viewart icle/758067. Accessed May 2012.

Order Your Test

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Mart in, C. and Beardsell, I. (2012 March 8). Is Rout ine Coagulat ion Test ing Necessary in Pat ient s Present ing
t o t he Emergency Depart ment Wit h Chest Pain? Medscape News Today from Emerg Med J.
2012;29(3):184-187 [On-line informat ion]. Available online at ht t p://www.medscape.com/viewart icle/759433.
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Marlar, R. and Gausman, J. (2011 February 23). Do You Report an Accurat e Int ernat ional Normalized Rat io?
Find Out Using Local Verificat ion and Calibrat ion. Medscape Today News from Lab Med. 2011;42(3):176-181
[On-line informat ion]. Available online at ht t p://www.medscape.com/viewart icle/737622. Accessed May
2012.

Dugdale, D. (Updat ed 2011 February 13). Prot hrombin t ime (PT). MedlinePlus Medical Encyclopedia [On-line
informat ion]. Available online at ht t p://www.nlm.nih.gov/medlineplus/ency/art icle/003652.ht m. Accessed
May 2012.

(2014 November 18, Updat ed). A Pat ient 's Guide t o Taking Warfarin. American Heart Associat ion. Available
online at ht t p://www.heart .org/HEARTORG/Condit ions/Arrhyt hmia/Prevent ionTreat ment ofArrhyt hmia/A-
Pat ient s-Guide-t o-Taking-Warfarin_ UCM_ 444996_ Art icle.jsp. Accessed on 4/05/15.

Tuazon, S. and Scarpaci, A. (2014 November 21, Updat ed). Prot hrombin Time. Medscape Drugs and Diseases.
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