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.