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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Remedy For Multiple Ailments

Hi there, I have a query about my grand father who is 88 years old. He is taking warfarin due to a dvt in 2009, following a cva. His Inr reading 4 days ago was 4.9 and his warfarin was stopped for two days then restarted at 3mg and 4mgs over the past two days. He blacked out 4 days ago and has been light headed, his skin is incredibly itchy, bowel movements have been mustartdy in colour, he has dark rings under his eyes and his skin appears slightly jaundiced. He has also been really sleepy the past few days.

Thanks,



S Greig
Tue, 24 Feb 2015
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Geriatrics Specialist,  's  Response
Hi Greig,
Thanks for asking.
Based on your query, my opinion is as follows.
1. High reading of INR means an increased risk of bleeding.
2. The INR needs to be maintained in the range of 2.5-3. Above it, increased risk of bleeding. Below it, increased risk of thrombus formation.
3. At present he appears to having symptoms of liver disease, along with obstructive features - giving symptoms of itchy skin and jaundice.
4. Need evaluation of serum bilirubin, liver enzymes - AST, ALT, and alkaline phosphatase. Also ultrasound abdomen and hemoglobin estimation is necessary for evaluation of any obstruction and the level of anemia. He might be excessively sleepy due to liver failure. The above tests are necessary for further evaluation.
Hope it helps.
Any further queries, happy to help again.
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Suggest Remedy For Multiple Ailments

Hi Greig, Thanks for asking. Based on your query, my opinion is as follows. 1. High reading of INR means an increased risk of bleeding. 2. The INR needs to be maintained in the range of 2.5-3. Above it, increased risk of bleeding. Below it, increased risk of thrombus formation. 3. At present he appears to having symptoms of liver disease, along with obstructive features - giving symptoms of itchy skin and jaundice. 4. Need evaluation of serum bilirubin, liver enzymes - AST, ALT, and alkaline phosphatase. Also ultrasound abdomen and hemoglobin estimation is necessary for evaluation of any obstruction and the level of anemia. He might be excessively sleepy due to liver failure. The above tests are necessary for further evaluation. Hope it helps. Any further queries, happy to help again.