Highest INR....

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Hello All, just a quick question or two...what is the highest INR you have seen, without any outward or inward evidence of bleeding? Last night I had a pt who had an INR of 17.9!!!!!! OMG, I was terrified. He got 2 units of FFP one unit of platelets, and 10 of Vitamin K IV. Eeeeep. Also, since I am an ER newbie, I didn't know that you can give the vitamin K iv. I thought you can only give it SQ.

Specializes in Float pool for 14 months.

Previously, I've only given it SQ. When the dr said iv, I looked @ my preceptor like he had ten heads. Because I come from basically med/surg, I really haven't dealt with such a critical level as I did last night.

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30. i'll never forget it. he broke his hip and had a small laceration of his hand that kept bleeding. ...

Holy!

Did he fall after snorting rat poison?

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Specializes in Family Practice.

We had a pt at my clinic a few weeks ago at 17.9. She came in complaining of pain in the side of her tongue, she was bleeding into the tissue. We only gave her PO Vitamin K and the next morning her INR was back in normal range.

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Specializes in Trauma ICU, Peds ICU.

I'll never forget it... INR was 33.2. Ended very badly.

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Specializes in LTC, Subacute Rehab.

11. Pt had spontaneous hematuria, but ultimately was OK.

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Specializes in Medical.

Wow - I thought my highest (9.7) was impressive!

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Specializes in Surgical, quality,management.

off on a slight tangent but biochem rang the nurse in charge mobile AKA the "batphone" because it is for emergencies to tell me of a pt with a K+ of 32. My answer was "he's still alive!!!" Wasn't haemolysed or anything only bloods he had done that draw. Sent off another ultra urgent it was 4.3. Still wondering how that happened.

Best INR I have seen was 11.2 blood products going in as fast as we could get them up. Turned out to be some sort of secreting tumour. Stabilised and resected as much as possible. Sent her home with a stoma She woke up one morning 2 weeks post op at home with a bag full of blood and died en-route to hospital.

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Specializes in Emergency, Cath Lab.

Initial PTT and INR of *comment* -meaning it wouldnt clot AT ALL.

Redraw after FFP, vit K, blood was INR 37.5, PTT >600. Dialysis patient on coumadin who was given an accidental OD of heparin during dialysis than sent to us. Shes actually doing just fine believe it or not. Super scary though!

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Specializes in Management, Emergency, Psych, Med Surg.

Yes, it is safe to give vit K by the IV route when you are in a situation where you have a very high INR and you have a trauma situation or you are attempting to get the INR down to a safe level in order to get a patient ready for surgery but you must watch the patient for potential life threatening reactions. IV route onset of action is 1-2 hours with a half life of 12 hours. The oral route is still the preferred route of administration but it takes longer to work and is not the preferred method for an acute need.

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