INR 11 and no Vitamin K??

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my patient's pt was >100 and inr 11. i called doctor and he didnt want me to give any vitamin k injection but to hold his coumadin. we've been holding holding his coumadin in the last few days and inr is still high. dont you think vitamin k should be given? do you usually give vitamin k when inr is usually this high?

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Specializes in CTICU.

Er.. yes. I work with patients who are all on coumadin, and we worry about head bleeds once INR is over 4ish (depending on pt pathology). We've let it get to around 6 before reversing due to the risk of thrombosis if we overshoot the other way. We recently had a patient at around 9-10 and he was admitted for Vit K and to watch.

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Specializes in EMS, ER, GI, PCU/Telemetry.

holy moly!

i've given vit K for INR @ 6+. usually an INR that high is considered pretty critical.... i've only had one pt get up to 10 and i had to give him vitamin K and FFP too.

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Best is to ask the MD why he is not treating it. Just be respectful. Seems like treating would by the best option, but maybe this pt has had embolic strokes before or some other reason that the MD is scared to reverse with Vit. K.

In the mean time, keep the pt on bedrest, no injections, esp. not IM, soft toothbrush, hold pressure for a while if you HAVE to d/c a line, fall/ injury prevention measures... you get the picture.

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Specializes in RN, BSN, CHDN.

FFP? maybe

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This is when you have to be the patient advocate, if this DR. wont do anything, you have to. Tell the patient to go to the ER if you need to, but take care of them, that is your responsibility to the patient ( and why you have a license ). There are other ways to get vitamin K into the patient as well, think diet.

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Specializes in Cardiac Telemetry, ED.
Best is to ask the MD why he is not treating it. Just be respectful. Seems like treating would by the best option, but maybe this pt has had embolic strokes before or some other reason that the MD is scared to reverse with Vit. K.

In the mean time, keep the pt on bedrest, no injections, esp. not IM, soft toothbrush, hold pressure for a while if you HAVE to d/c a line, fall/ injury prevention measures... you get the picture.

I'm in agreement with this. There could be a reason the doctor is choosing to treat this by holding the warfarin. The half life of warfarin is 2.5 days, so simply holding the medication for a few days until the INR is back down to the desirable level might be a reasonable course of action in the doctor's mind. In addition, the administration of vitamin K can contribute to warfarin resistance, making it even more difficult to keep the patient adequately anticoagulated in the future. It sounds to me like anticoagulation is crucial for this particular patient's well being, and the doctor is choosing a conservative approach, weighing the risks vs. benefits. It may help ease your mind a bit to simply ask the doctor, in a nonconfrontational way, what his thinking is.

In the meantime, make sure the patient is on bleeding precautions, assess and monitor the patient for any s/s of hemorrhage, and be ready to respond appropriately should the need arise.

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Specializes in Utilization Management.

I can't recall where, but awhile back I read a study that said that the benefits of administering Vit K were negligible and simply withholding Coumadin was a satisfactory option.

Has the patient had problems with regulating PT/INR before? Why is the patient on Coumadin? Does the patient trend toward hypercoagulopathy, for instance, are a couple of questions I would ask, along with asking the doc why he chose to go this route before I bumped the problem up the chain. I'd be curious and want to know just for the sake of learning why, myself.

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