Emergency Medical Minute9 Mar 2021

Podcast 647: INR and Liver Failure

Contributor: Erik Verzemnieks, MD

Educational Pearls:

INR measures the clotting cascade including factors II, VII, IX, and X
Coumadin most commonly elevates the INR, and it is used to monitor the anticoagulant's effectiveness
Liver failure can cause a similar elevation in the INR due to lack of synthesis of factors II, VII, IX, X
An elevated INR in liver failure does not mean that the patient is anticoagulated, at increased risk for bleeding, or is at less risk of forming a clot
There is more commonly an increased risk of clot formation due to lack of production of protein C and S, which are natural anticoagulants
Lack of production of proteins C and S have a larger effect and lead to typically a net clotting risk
Levels of these can be indirectly measured through albumin
Portal venous thrombosis is one of the most common examples of this phenomenon

References

Harrison MF. The Misunderstood Coagulopathy of Liver Disease: A Review for the Acute Setting. West J Emerg Med. 2018;19(5):863-871. doi:10.5811/westjem.2018.7.37893

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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