Podcast 647: INR and Liver Failure

<p><strong>Contributor:  Erik Verzemnieks, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">INR measures the clotting cascade including factors II, VII, IX, and X</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Coumadin most commonly elevates the INR, and it is used to monitor the anticoagulant’s effectiveness</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Liver failure can cause a similar elevation in the INR due to lack of synthesis of factors II, VII, IX, X</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">An elevated INR in liver failure</span> <em><span style="font-weight: 400;">does not</span></em> <span style="font-weight: 400;">mean that the patient is anticoagulated, at increased risk for bleeding, or is at less risk of forming a clot</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">There is more commonly an</span> <em><span style="font-weight: 400;">increased</span></em> <span style="font-weight: 400;">risk of clot formation due to lack of production of protein C and S, which are natural anticoagulants</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Lack of production of proteins C and S have a larger effect and lead to typically a net clotting risk</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Levels of these can be indirectly measured through albumin</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Portal venous thrombosis is one of the most common examples of this phenomenon</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Harrison MF. The Misunderstood Coagulopathy of Liver Disease: A Review for the Acute Setting.</span> <em><span style="font-weight: 400;">West J Emerg Med</span></