INR increasing...without anticoagulation? - page 2

by LetsChill

22,925 Views | 17 Comments

I've had several pts with multiple different diagnoses and admitting problems whose INR continued to increase daily despite holding Lovenox, Coumadin, etc. One pt had daily INRs of 6.3, then 7.1, then 7.4. All the while holding... Read More


  1. 0
    Also, if the patient has cancer, they usually have low albumin (either d/t the disease process or malnutrition); low albumin can affect protein binding, making more warfarin stay in the system longer. I know seems particularly tricky to anticoag someone with GI CA and liver CA who need something due to afib, artificial valves, etc. Lovenox works better than warfarin in those cases, in my experience.
  2. 0
    Exacly what I was thinking. Once had a patient that was getting multiple doses of vit k and the inr was still 13. He was on Cipro
  3. 0
    Warfarin pretty much interacts with EVERYTHING. Two drugs that come to mind are levoquin and amiodarone.
  4. 4
    If INR is 13 despite multiple doses of Vitamin K, it's time to give some FFP and get it down. That's a cerebral hemorrhage waiting to happen!
  5. 0
    Tylenol can also interfere with Coumadin metabolism and in turn affects your liver which can further interfere with metabolism...I had a patient with an INR of 9.9. Took a lot of Tylenol. That patient got some bags of FFP and INR stabilized
  6. 0
    It may be due to HIT (Heparin induced thrombocytopenia)...just a thought
  7. 0
    heparin induced thrombcytopenia... liver failure, sepsis
  8. 0
    regarding to the wide drug interaction between Comadin and many drugs, please consider following items.
    Independent risk factors for an increased risk of INR above 6.0 were:
    • advanced malignancy,
    • newly started medicines with the potential to interfere with warfarin metabolism
    • taking more warfarin than was prescribed
    • a decreased consumption of foods rich in vitamin K
    • acute diarrheal illness


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