INR LABS

[nikita12]

Hi guys i am a new nurse working in lonterm care facility. I ha a question regarding INR labs value. so when its high we always call doctor. what if its low? since i am anew nurse i am so scared caling the doctor. can someone please give me an example of how to call a doctor for instance, Hi this is...i am calliding regarding,,so and so,,,PLEASE..thankyou

[Silverdragon102, BSN]

I guess I am lucky as we have a NP that we can discuss INR's etc with and they if necessary do the discussion with the doctors

[PyridiumP]

An embolus can travel anywhere that blood flows. A fib is a definite risk factor for DVT in stroke patients. http://stroke.ahajournals.org/content/22/6/760.full.pdf

I understand how a fib causes clots to form.

Maybe I should have said VTE prophylaxis instead of DVT prophylaxis to be more inclusive.

Reading that 27-year-old paper (which cites papers from the 80s) does not support the contention that AF causes deep venous thrombosis. The best it can do is say that they may be associated, but association is not causation. (It also says that there is no consensus for anticoagulation therapy in AF, citing papers from 1986 and 1988. I believe that ship has since sailed.)

This demonstrates the risk of not understanding the entire article-- it doesn't say what you think, once you read it in its entirety.

Last: Saying atrial emboli can travel anywhere bespeaks a misapprehension of circulatory anatomy. Tell me how an atrial clot from either right or left atrium travels and gets into deep veins. (I'll wait.) (Hint: capillary beds)

[Lev, MSN, RN, NP]

Reading that 27-year-old paper (which cites papers from the 80s) does not support the contention that AF causes deep venous thrombosis. The best it can do is say that they may be associated, but association is not causation. (It also says that there is no consensus for anticoagulation therapy in AF, citing papers from 1986 and 1988. I believe that ship has since sailed.)

This demonstrates the risk of not understanding the entire article-- it doesn't say what you think, once you read it in its entirety.

Last: Saying atrial emboli can travel anywhere bespeaks a misapprehension of circulatory anatomy. Tell me how an atrial clot from either right or left atrium travels and gets into deep veins. (I'll wait.) (Hint: capillary beds)

Wow you're really smart. Thanks for the info!

[mago8388]

I think the Doc and the patient will appreciate the call. The patient needs to have a therapeutic level of Coumadin to prevent a blood clot. INR low and this can happen, too high and the patient can hemorrhage. If he doesn't increase the Coumadin that's on him but at least you documented that the Doc was notified and the action he took or lack thereof.