My partner when he was 28yrs old, was admitted to hospital with severe abdo pain after taking Ceclor antibiotic for a suspected sinus infection (INR on admission was 3.2). He had known Antiphospholipid disorder and was on warfarin at the time. He had CT scanning which showed a distended bowel (constipation for 4 days). His creatinine was 90, no obstruction in the ureters were detected and no kidney stones, but filling defects were noted that were thought to be not consistent with air bubbles. He was however admitted under urology and underwent retrograde pyelography, cystoscopy and insertion of ureteric stents, and catheters. The pain did not subside and the creatinine steadily rose to 360. the urologist removed the stents and reinserted them, the creatinine rose further and another 3 procedures were undertaken over the next 24 hours. His creatinine was 1200 by this stage and was in complete renal failure. The CT scan and MRI showed a left adrenal haemorrhage after first operation and was found to be over-anticoagulated, INR was 8.7 during 2 operations and 11.7 on the last. His INR was not monitored for 2 days (1 of those a surgery day, and reading the following days INR of 8.7 was likely to be out of the theraputic range).
He subsequently was given vit K and INR came down to 1.5 at which time a needle biopsy was performed. His kidney unfortunately bled out and is now non-functioning. It showed type 4 lupus nephritis. His right kidney is also impaired with a creatinine sitting around 240. He had other complications following this ordeal, AF, due to overhydration, multiple DVT's and PE's, stroke, heart attack etc.
... What I want to ask you is, in your opinion, is it usual practise to undergo these type of procedures with a known grossly over anticoagulated patient, without reversal?
Would bleeding internally be a much higher risk?
Can cysoscopy itself cause adrenal haemorrhage and or ARF? Or is it likely to be the "high" INR?
Your expert opinion would be GREATLY appreciated.