Error in Warfarin Dosage Causes Serious Injuries

I am a practicing pediatric cardiologist. I commonly treat patients with this presentation and manage patients who receive coumadin for anticoagulation. An INR level this high should result in an adjustment of the patient’s dose, generally within 24 hours. There are many factors that can affect the INR and coumadin requirements, so it would be important to know the patient’s prior dose, any changes in diet or other medications, and any intercurrent illnesses. Management of coumadin levels can be challenging, but it is clear that this level should have resulted in an adjustment of her dose at a minimum. INR levels that are too high can result in bleeding complications, including cerebral hemorrhage. INR levels that are too low can result in clot formation, which can also result in strokes or other embolic events. Therefore, it is important to routinely follow INR levels and then promptly adjust the coumadin dosage as needed.