INR increasing...without anticoagulation?

Specialties CCU

Published

I've had several pts with multiple different diagnoses and admitting problems whose INR continued to increase daily despite holding Lovenox, Coumadin, etc.

One pt had daily INRs of 6.3, then 7.1, then 7.4. All the while holding any meds that would increase it. Docs wanted to wait and see if it would go down on its own before treating it.

Why would an INR increase like this, even without administering anticoagulants?

Warfarin pretty much interacts with EVERYTHING. Two drugs that come to mind are levoquin and amiodarone.

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Specializes in CTICU.

If INR is 13 despite multiple doses of Vitamin K, it's time to give some FFP and get it down. That's a cerebral hemorrhage waiting to happen!

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Specializes in ER, progressive care.

Tylenol can also interfere with Coumadin metabolism and in turn affects your liver which can further interfere with metabolism...I had a patient with an INR of 9.9. Took a lot of Tylenol. That patient got some bags of FFP and INR stabilized :)

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It may be due to HIT (Heparin induced thrombocytopenia)...just a thought

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heparin induced thrombcytopenia... liver failure, sepsis

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Specializes in Critical care (coronary care).

regarding to the wide drug interaction between Comadin and many drugs, please consider following items.

Independent risk factors for an increased risk of INR above 6.0 were:

  • advanced malignancy,
  • newly started medicines with the potential to interfere with warfarin metabolism
  • taking more warfarin than was prescribed
  • a decreased consumption of foods rich in vitamin K
  • acute diarrheal illness

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