INR 6.5

  1. I had a pt today with a INR of 6.5. I called the doctor. He told me to hold todays coumadin and monitor for bleeding. I work nights and was ready to leave. So I put that order in. Told the nurse comiing on and manager what happened and what the doc said.

    But it really didn't seem like enough.

    Possibly they will change the dose later on in the day as they often do since managers call with the results later and talk to the docs about the levels when there normal. I'm sure thats what there gonna do.

    Any thoughts?
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  2. 8 Comments

  3. by   BostonFNP
    Quote from goalienrse
    I had a pt today with a INR of 6.5. I called the doctor. He told me to hold todays coumadin and monitor for bleeding. I work nights and was ready to leave. So I put that order in. Told the nurse comiing on and manager what happened and what the doc said.

    But it really didn't seem like enough.

    Possibly they will change the dose later on in the day as they often do since managers call with the results later and talk to the docs about the levels when there normal. I'm sure thats what there gonna do.

    Any thoughts?
    It's a reasonable plan. Normally for a symptomatic INRs less than 9 I hold two days and monitor plus precautions.

    I would be looking for a cause though.
  4. by   turnforthenurse
    Quote from BostonFNP
    It's a reasonable plan. Normally for a symptomatic INRs less than 9 I hold two days and monitor plus precautions.

    I would be looking for a cause though.
    I agree, it's reasonable.

    They may decide to give the patient a dose of vitamin K, though, depending on the doc.
  5. by   BostonFNP
    Quote from turnforthenurseRN

    I agree, it's reasonable.

    They may decide to give the patient a dose of vitamin K, though, depending on the doc.
    Also reasonable. The former a bit more conservative the latter a tad more aggressive. Depending on the patient and etiology I would consider a small oral VItK dose.
  6. by   Esme12
    If there is no other evidence of bleeding this is what is usually done....sometimes if bleeding occurs cryoprecipitate or FFP may be given after Vit K.
  7. by   goalienrse
    Ok, great. Haven't been taking INRs very long at this place and unsure, new nurse here. Thanks everyone
  8. by   Esme12
    anytime...
  9. by   classicdame
    seems the MD should have ordered an INR be drawn later in the day. Let's hope he considered that when making rounds.
  10. by   BostonFNP
    Quote from classicdame
    seems the MD should have ordered an INR be drawn later in the day. Let's hope he considered that when making rounds.
    I usually wouldn't repeat an INR until 24 hours out unless they already had taken the daily dose.

    Does your facility do this differently?

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