Highest INR....

1 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.
10.5Friend gave him some wierd tea he had been swilling at home. Lots of FFP!!TaitPS. We are giving a lot of our Vit K PO.

PO? I know they have it po, and I've seen it, but if a pt needs the vitamin k stat for a high inr I would think sq, or now iv as I have learned would be the best bet. Unless the po is given in a non emergent situation.

27? Something absurdly high like that, I can't remember the exact number. With esophageal varices, to boot. Hemorrhaged out, as many bandings as the GI doc did at bedside, new ones began bleeding. Eventually, we had to give up. I think that was after 12 bandings and numerous new bleeds. Very sad.

Quote from FiduciaRNPO? I know they have it po, and I've seen it, but if a pt needs the vitamin k stat for a high inr I would think sq, or now iv as I have learned would be the best bet. Unless the po is given in a non emergent situation.

14.9 with no vit k til 2nd day of admission, complaining of a backache "I think my kidney stones are back", no-that would be the big, fat retroperitoneal bleed! :/

Quote from FiduciaRNPO? I know they have it po, and I've seen it, but if a pt needs the vitamin k stat for a high inr I would think sq, or now iv as I have learned would be the best bet. Unless the po is given in a non emergent situation.

30. i'll never forget it. he broke his hip and had a small laceration of his hand that kept bleeding. i was really concerned. lots of FFP/VitK and he actually made it to surgery 2-3 days later. i remember the surgeon coming in and i told him about the inr. he said, "oh you mean the ptt." ahh, no. haha. nice guy. hope he's doing ok now.

I actually had two pts leveled in the ER last d/t falls and being on coumadin. One dude had a inr of 8.6, he got 4 units of FFP and 10 vit k iv bc he had a retroperitoneal bleed and he tore a vessel in his chest he was young 47. The other man with the 17.9, I'm gonna suspect had a bleed that wasn't found initially bc he was hypotensive after many boluses, ffp, platelets, and the vit k iv, plus he needed factor 7 I believe. He was a mess the poor guy. I swear there was a dang full moon last night in the ER.

We had someone who hit 9. Nothing bad came of it, thank goodness.

I had one patient who had an INR that was 18. FFP and blood was given, along with vit k. Nothing bad came of this.

Actually, administering Vit. K IV comes with a lot of risk so unless there is a highly critical need for that route - the SQ and PO routes are preferred.

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.