Anyone ever seen a 17.2 for an INR

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Yes, I said a 17.2 INR. AND we rechecked it. Pt had not taken coumadin in 4 days. Not on antibiotics, not drinking alcohol. Could his liver function have something to do with how he is processing his other meds to make his INR that high? Odd thing is, no bleeding anywher. Notta nothing.

Thanks for your input.

Cris

Specializes in Med/Surg, Geriatric, Hospice.

Had a 23.1 last month. ABX interaction coumadin.

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Coumadin has a longer half life so it may take some time for it to normalize. Maybe his liver is not produce coag factors. He would need additional blood testing for this. They can be infused in FFP in the meantime. Is his H+H normal?

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Compliance error is a big reasons for high INR, ASA, cough and cold OTC remedies, dietary supplements like garlic increase bleeding time, Many prescriptions meds can increase INR(Antibacterial drugs, antifungals, antiseizure, cardiovascular, GI drugs, Thyroid preps). Liver disease, biliary disease(obstructive jaundice) malabsorption, hyperthyroidism, and fever increase drug effect by reducing the absorption of vit K and decrease hepatic syntheses of coag factors or increase breakdown of coag factors.

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Specializes in LTC.

Holy Cow!!!!

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WOW!!!! The highest I have seen is 13.2 on a Tylenol OD. Bled from every oriface of his body. AST/ALT were in the 12,000. Poor thing died less than 48 hours later. His OD was accidental. He didn't follow label directions. I hate acetaminophen for this very reason. People with a lesser education/comprehension level cannot always understand OTC labels. And do not always understand that Thera-flu and Tylenol both have acetaminophen. And they accidentally over-do it. Add a little compromised liver function due to ETOH to the equation and it can spell disaster. :-(

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Specializes in Med/Surg.

I had a 14.something in a patient that was supposed to be transferred to rehab s/p ischemic stroke (insurance issues were the only reason pt was not dc'd that day). Neuro assessment was different than what was received in report (unsure of whether it was a clinical change or poor report0 and that was the first definite sign something was really wrong. Pt ended up converting from an ischemic to a hemorrhagic stroke and unfortunately did not make it.

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