Adult Critical Care Specialty (ACCS) Practice Exam

Which laboratory result indicates active bleeding in a patient on anticoagulation therapy?

1. Platelet count of 300,000

2. Prothrombin time of 35 seconds

3. Hematocrit of 42%

4. INR of 3.0

The correct answer is: INR of 3.0

An INR (International Normalized Ratio) of 3.0 indicates a significant level of anticoagulation, which increases the risk of bleeding. In patients who are on anticoagulation therapy, particularly with warfarin, the therapeutic range typically targets an INR of 2.0 to 3.0 for most conditions, while an INR above this threshold, especially above 3.0, suggests a higher risk for bleeding complications. In the context of active bleeding, if a patient has an elevated INR, it demonstrates that their blood is not clotting effectively, which would compromise hemostatic ability during a bleed. Therefore, an INR of 3.0 is a strong indication of potential bleeding risk in a patient receiving anticoagulant treatment. The other laboratory results provided do not indicate active bleeding. A platelet count of 300,000 is within the normal range, a prothrombin time of 35 seconds also suggests a coagulopathy but not specifically an active bleeding state, and a hematocrit of 42% is within normal limits, indicating stable blood volume. Thus, the INR of 3.0 is the most telling indicator of potential complications and active bleeding in a patient on anticoagulants.