Abdul Muqtadir Abbasi: When a High INR Hides a Thrombotic Cancer
Abdul Muqtadir Abbasi, Assistant Consultant at King Faisal Specialist Hospital and Research Center, shared a post on LinkedIn:
“You are consulted for a 30 yr old male patient with high INR , planned for a biopsy of liver for suspected liver lesions. Current INR is 2 and radiology wants an INR or <1.5 .
You prescribe FFPs to correct INR and proceed for biopsy, however……
You study the case and find an interesting phenomenon that takes place with gastric tumors.
The culprit is mucin producing tumors.
These tumors cause initiation of thrombus formation causing high d dimer and consumption of coagulation factors like fibrinogen.
What to do now.
In these cases , if biopsy done, patient will bleed significantly. First thing first, try to avoid any invasive procedure in this time. Start anticoagulation prophylactic dose or low dose.
This helps decrease thrombus formation and self recovery of fibrinogen.
FFPs do not correct the INR.
You review the patient and try to find a reason.
Patient is having high CA19-9, a marker for gastric, pancreatic malignancy. You immediately check d dimer and fibrinogen.
D dimers are high and fibrinogen very…low. The real story starts here.”
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