Question about INR

I'm waiting to hear from my brothers Dr today. He sounds better than yesterday on the phone (not as crabby). For the past week his INR has been at 2.7 so they can't "tap" him. The last time they tapped him was on 4/11 almost 3 weeks ago and they took 3.5 liters out. They have him on a 1 liter a day fluid restriction. What if they INR doesn't go down and they can't tap him? Then what happens if the fluid keeps building?

My other issue I'm dealing with is the hospital social worker told me yesterday he can be accepted into an LTAC (long term acute care facility) after he's released from the hospital. Now today the LTAC people are saying he's "not medically complex" so they won't take him, even though on Monday I had a meeting with my brother, the hospital social worker and his Dr who all agreed he should go there. The LTAC people are saying he's ambulatory and he can be taken to a hospital from a nursing home to get tapped if he needs to etc. I worry because when he first left the first hospital and went to a nursing home thats when things went downhill with his kidneys. So far his kidneys are improving which leads me to believe it was due to dehydration (I'm going to talk with the dr more about this today) because he was on multiple diuretics at the nursing home. I'm not blaming the nursing home, but I worry if he goes back to one what if things get worse again because he might need a higher level of care.

Today his MELD is 34. It came down from 40 at the end of last week, but has stayed around 33-34 all this week. The INR is not moving. His ALT and AST are not budging either. His creatinine is 1.75 (keeps lowering so that's good) bilirubin down some to 16. His platelets are 86, of course his blood pressure is low. His ammonia is 50, they gave him lactulose yesterday, he's still having urine and bowel movements (multiple times a day) so that's good. He's alert, awake, eating, able to get up and down to go to the bathroom, not confused. The Dr told me if the INR doesn't change they COULD tap him but it would be very risky so right now they're just monitoring that.

I voiced my concerns to the hospital social worker about him not being accepted and she had the nurse in charge at the LTAC contact me. Such a sweet, sweet lady! She too has an alcoholic family member, and as soon as she heard it was a sister concerned about her older brother, she told me "I HAVE to accept him!" Thank GOD for kind people!! Plus she reviewed his lab numbers and agreed he should go there. His Dr said they will transfer him there tomorrow and his state insurance covers it all!
And today marks 1 month of him being in the hospitals and being sober (if that counts for the documented sobriety)??

Ask if getting vitamin K and fresh frozen plasma will let them do the tap. My INR was at a 2.1 and they gave me 2 units and then I had liver biopsy and both vitamin K and fresh frozen plasma before I had my first ERCP. They worry about blood bleeding with both procedures when your INR is elevated.

I would think they could do same to do a tap if needed, but I am not sure if they would.

Do you know if TIPS is an ton. People have varied success with it when it comes to HE, but most all have fluid issues resolved. Maybe he needs to see some more improvement first though. I hope he sees some improvement.