Admission due to Subtherapeutic INR

I am stumped. This patient was admitted due to concern for subtherapeutic INR. Warfarin dosing appropriately. Cardiology was concerned due to high risk 2/2 aortic and mitral prosthetic valves, factor V leiden deficiency, pacemaker as well as finding of increased leg edema. History of radiation induced valvular disease in 2009, systolic CHF. Hospitalist is treating for CHFe as well by changing PO bumex to IV, same mg and schedule. CHFe and the INR have been treated equally it would seem. Currently I have CHFe as my PDx, but am wondering if it should be more related to the subtherapeutic INR. Your thought and codes are appreciated.

Comments

  • Was the suspected subtherapeutic INR ruled out or confirmed by labs? Was treatment altered? Could the work-up, etc. for subtherapeutic INR have been done as an outpatient? What was the s/s that prompted the concern for subtherapeutic INR?

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