High INR on warfarin

The bottom line Clarify the warfarin dose that the patient is taking, and check for co-existing problems (such as liver disease or cancer), dietary changes, and intake of alcohol and other drugs that may increase risk of bleeding or affect international normalised ratio control Urgently refer all patients with suspected intracranial or gastrointestinal bleeding to secondary care A 72 year old woman, who had been diagnosed as having recurrent deep vein thrombosis six weeks earlier, attends the practice's phlebotomy clinic for an international normalised ratio (INR) check. Compared with warfarin, both dabigatran and rivaroxaban seem to have fewer interactions with other drugs, so anticoagulant monitoring is not recommended by the manufacturers, although this advice remains controversial. [...]both drugs are contraindicated in patients with poor renal function and the pharmacological actions of these agents are irreversible in the event of bleeding. 6