Supratherapeutic international normalized ratio: an indicator of chronic malnutrition due to severely debilitating gastrointestinal disease

This case highlights the fact that Supratherapeutic INRs direct the attention of the treating physicians' team to the underlying severely debilitating gastrointestinal diseases. Prolonged fasting or starvation reduces vitamin K levels. Such patients are more sensitive to treatment with Vitamin K antagonist-based anticoagulants. Hence, the Supratherapeutic INR can be an objective indicator of chronic loss of appetite with poor nutritional status of the patient and therefore acts as a warning sign for diagnosis of severe debilitating primary gastrointestinal disease.