What's the use of Supratheraupetic INR?? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-05-2011
iron's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 229
Threads: 43
Thanked 51 Times in 42 Posts
Reputation: 61
Question What's the use of Supratheraupetic INR??

What is the use of supratheraupetic INR? I didn't understand the chart in kaplan regarding the management of different levels INR..can anyone tell me the benefits ?
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (05-05-2011), only2junk (05-05-2011)



  #2  
Old 05-05-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow

This is what I found on the net...

https://8887523543071465280-a-180274...attredirects=0
Reply With Quote Quick reply to this message
  #3  
Old 05-05-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow What do you do in these cases?

What do you do in these cases?

A man on coumadin for atrial fibrillation arrives because he has increased bruising on his skin. He is otherwise asymptomatic. He was told to come to the ED because of a lab result showing INR = 6.


A woman on coumadin for atrial fibrillation arrives because of melena and hematemesis. She looks extremely sheet-white pale. Her vital signs are surprising normal. Stat labs show a hematocrit of 15 and an INR value that the lab is "unable to calculate" because it is so high.
Reply With Quote Quick reply to this message
  #4  
Old 05-05-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow Answers to cases:

Answers to cases:

INR=6 with minimal symptoms: Hold coumadin +/- give vitamin K 1 mg po.


INR uncalculatable with GI bleed: Hold coumadin, FFP, pRBC transfusion, +/- factor concentrates, +/- vitamin K 10 mg IV slow push. (Doctors actually elected not to give IV vitamin K because of the risk of life-threatening anaphylaxis and the fact that the patient was relatively stable.)
Reply With Quote Quick reply to this message
The above post was thanked by:
1TA2B (05-05-2011), only2junk (05-05-2011)
  #5  
Old 05-05-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 351 Times in 169 Posts
Reputation: 374
Default

Quote:
Originally Posted by aktorque View Post
Answers to cases:

INR=6 with minimal symptoms: Hold coumadin +/- give vitamin K 1 mg po.


INR uncalculatable with GI bleed: Hold coumadin, FFP, pRBC transfusion, +/- factor concentrates, +/- vitamin K 10 mg IV slow push. (Doctors actually elected not to give IV vitamin K because of the risk of life-threatening anaphylaxis and the fact that the patient was relatively stable.)
Thanks aktorque-very useful!

How about in a patient on coumadin/warfarin for metalic heart valve with cerebral bleed?
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (05-05-2011)
  #6  
Old 05-05-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow

A 77 y/o man, has developed a right hemiparesis with expressive dysphasia. 2 years earlier he had undergone prosthetic aortic valve replacement together with coronary artery bypass grafting, since when he had been taking warfarin with a target INR of 2.53.5. On examination he was in sinus rhythm and normotensive, Glasgow Coma Scale 13/15. His dysphasia, sensory and visual inattention, and right hemiplegia were compatible with a left total anterior circulation stroke syndrome, and CT revealed a large left frontoparietal primary intracerebral haemorrhage. His INR was 3.2.

CT pic.
http://www.ncbi.nlm.nih.gov/pmc/arti...6/figure/fig1/

Clearly, this patient was at risk of further bleeding if the warfarin was continued but at risk of thromboembolism from the heart valve if it was stopped.

Doctors reversed the anticoagulation rapidly with Beriplexa prothrombin complex concentrate.

Conventional treatment was not used since with vitamin K the response is slow and unpredictable and with fresh frozen plasma it is rapid but short-lasting.

Beriplex has been available for about 10 years but only recently have its efficacy and safety profiles been published, it can stop bleeding immediately without acute risk of thromboembolism. I don't know that doctors widely using this drug in practice. I need to check on this....
Reply With Quote Quick reply to this message
The above post was thanked by:
1TA2B (05-06-2011), iron (05-05-2011), rozirose (05-05-2011)
  #7  
Old 05-05-2011
iron's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 229
Threads: 43
Thanked 51 Times in 42 Posts
Reputation: 61
Default

Thanks atorque..

i think this way we can clarify our doubts.I haven't seen uworld n kaplan talking about the drug ,u have talked about . Also ,kaplan also talked about the bleeding complications related to high INR and way to manage it ,but when it is used ,it is hardly mentioned.
Reply With Quote Quick reply to this message



Reply

Tags
Cardiology-, Hematology-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)