My 11 year old had an upper endoscopy 11 days ago and, per pediatric guidelines at the hospital, was required to bridge with lovenox. My concern is that it's now 11 days after the procedure, and we're still bridging with lovenox because her INR is only 1.9. We can't figure out why it's taking so long for her to get back into her range (2.5-3.5 as she has an MVR). Her cardiologist has had us increase her usual warfarin dose several times this past week, and she's still only inching up ever so slowly. In fact, three days after her dose was increased, her INR actually went down from 1.9 to 1.7. Has anybody had any experience with this? Because she has minimal body fat, I was told to give her the lovenox injections in her thighs, and they're pretty bruised at this point.