Cautionary tale about not panicking over an elevated INR

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Well-known member
Apr 29, 2014
I just wanted to share an interesting elevated INR experience in case it could prove helpful for others. On June 21, my 19 year old daughter who has an On-X mitral valve became very sick with a gastrointestinal virus. Interestingly, we know the exact virus because her sister had been very ill the previous week for five days and was so weak that her doctor ordered a stool sample which was tested and came back positive for the Adenovirus F 40/41 virus (know to cause acute gastroenteritis). I test my 19 year old at home weekly (she has Down syndrome, which is why I do the testing). The day before she became ill, her INR was 2.3. After three days of persistent diarrhea and fatigue, I decided to test her INR as I was worried that it might be high due to the fact that she was not eating and was probably getting dehydrated. Sure enough, three days into the virus on a Sunday morning, her INR was 5.7. I withheld her warfarin dose that evening, and the following morning decided to test her again to see if her INR had come back down. Imagine my surprise when it was now 7.1 despite having no warfarin the evening before. At this point, she had started vomiting frequently in addition to the diarrhea. I withheld her warfarin dose a second night and tested her again the next morning. Her INR had come down to 5.6. The clinic advised that I give 1 mg of warfarin that evening instead of the usual 6, and when I tested her the next morning, her INR was down to 3.0. The following day it was back up to 3.9, so I gave her 1 less mg of warfarin than usual. I just tested her again after a week of her usual warfarin doses, and her INR was 3.1, just where it should be.

I'm really glad neither we nor the nurse at the clinic panicked at all about the high INR. All in all, my daughter experienced symptoms from the virus for 6 days, including extreme exhaustion.

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