Podcast 647: INR and Liver Failure

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