Anyone ever seen a 17.2 for an INR

JeneraterRN · Oct 5, 2011

Yikes, I saw a 15 once because the patient didn't understand his dosing instructions. He was oozing in his gums and positive for blood in an UA with a clean micro, but otherwise came out unscathed. How were his LFT's? He may not have been producing clotting factors properly. This is assuming he has no congenital bleeding disorders. Was he a new coumadin patient?

LVN2beRN · Oct 5, 2011

LFTs were off the chain. No he had been on coumadin for quite a while.

Long Term Care Columnist / Guide · Oct 5, 2011

Whew! I wouldn't have wanted to even breathe on that patient for fear of causing him to bleed to death :eek:

I have seen one INR that was even higher though---19.2. I remember thinking that reading had to be a misprint on the STAT lab report, but sure enough, the tech called up to the floor to confirm it. My patient was on heparin and I almost broke a couple of track records getting down the hall to shut off the infusion. He was back down to therapeutic levels within a relatively short time, but I was in fear the entire shift that he'd get up and fall, or bump into something........thankfully he was A &O and could understand why I didn't want him to move!

whitebunny · Oct 5, 2011

i have seen 10.2. Peeing blood, nose bleeding, decrease consciousness---sending to hosp----upset families. Regular dose warfarin 1mg, INR has been steady before.

xtxrn, ASN, RN · Oct 5, 2011

Had an ED doc tell me of an INR higher than that (don't remember for sure, but 20-something) and the patient did fine.

Cranberries are an issue- any of those involved? :)

I'm so glad to be off Coumadin.... 20mg/day EVERY day got my INR to 1.2.... for months. Finally got on Pradaxa... no tests- but not dead (and I'm not an a fib)

Boston-RN, RN · Oct 5, 2011

11.7 on a headbleed with a shift but we saved her.....26 (lab couldn't go any higher) on a tylenol OD that did not survive

TonyaM73, ASN, RN · Oct 5, 2011

I had a 16.8 on admission once. Pt felt dizzy and fell down that was why EMS was called and she came in. (Covered with terrible bruises) She had been on Coumadin for a few months, but she had forgetfullness. She swears that she was taking it as usual and just ate a few less greens than she was used to, but my thoughts are she forgot that she had taken it and had been taking a second dose. Who knows for sure though.

pfongk · Oct 5, 2011

Yep it was about 17. something. I can't remember though. Luckily I held the warfrin because I hadn't got the INR result yet from pathology. I rang pathology to chase it up because this guy was a new admit from another nursing home and ended up speaking to the head pathologist while they ran the result through for the 3rd time. He ended up being fine. He'd been self medicating at the ALF he was in before he came to our LTC

nrsang97, BSN, RN · Oct 5, 2011

My brother in law had an INR of 30. Yes you read that right. He did have bloody urine. His liver enzymes were off and NO coumadin. He ended up being fine. We aren't sure of the cause two years later.

beckster_01, BSN, RN · Oct 5, 2011

I'm so glad to be off Coumadin.... 20mg/day EVERY day got my INR to 1.2.... for months. Finally got on Pradaxa... no tests- but not dead (and I'm not an a fib)

I LOVE pradaxa lol. One of our surgeons has been using it for a year on select patients. It's about time they developed an anticoagulation medication that isn't so easy to screw up! I worry about my 80+ year old patients who require alternating doses of coumadin, and may not remember about the dietary considerations/blood draw requirements to keep a safe level...

belgarion · Oct 5, 2011

I had a pt. who was pushing a 30 once. Believe it or not he was totally asymptomatic. He said he hadn't gotten around to having his levels checked for about the last 6 months. I really wanted to say something but I bit my tongue and left it to his wife who DID have a lot to say to him.