Over the following days, the results of coagulation tests are shown in the Table. A mixing study is done and shows PTT corrected to 37 seconds and INR to 1.6. However, before planned discharge, a repeated PTT is 115 seconds and INR is 10.6. Vitamin K 5.0 mg is given orally, which results in a PT of 55 seconds and an INR of 6.0 the next morning. Partial thromboplastin time (PTT) is 90 seconds prothrombin time (PT), 65 seconds and INR, 9.6. Albumin level is 3.2 g/dL alanine aminotransferase, 11 U/L and aspartate aminotransferase, 14 U/L. Results of the admission hemogram and chemistry panel are normal. There is bilateral (12) pedal edema with hemosiderin deposition in both ankles. Results of the head, eye, ear, nose, and throat examination are normal. Blood pressure is 158/94 mm Hg heart rate, 88 beats per minute and respiration rate, 16 breaths per minute. This obese woman is in no apparent distress.

She denies any recent changes in medications or dosage. Medications include albuterol, fluticasone/salmeterol, metoprolol, and occasionally alprazolam. She has a history of asthma and hypertension. She denies any pulmonary symptoms but is troubled by periodic pain and swelling in her legs, which she states is due to her “blood clots acting up again.” She reports no hemorrhagic symptoms. Her usual warfarin dosage is 5.0 alternating with 7.5 mg daily, and there has been no change in recent months. A vena cava filter was placed 5 years ago. She has had multiple episodes of DVT and a pulmonary embolism in the intervening years. Evaluation at that time revealed factor V Leiden heterozygosity.

Her first episode of deep vein thrombosis (DVT) was in 1999 and was idiopathic. She takes warfarin for a thromboembolic diathesis of 10 years’ duration. A 44-year-old woman is hospitalized for evaluation and management of an excessively elevated international normalized ratio (INR).

Inr antidote