Elevated INR without warfarin

[angelcantrell1985]

So I need some help doing a care plan. The diagnosis is elevated INR rt leg wound. I have been looking up INR and everything talks about warfarin and blood thinners, but the patient isn't on any. I am very confused and appreciate any insight you may have for me.

Thanks,

Angel

[ghillbert, MSN, NP]

Elevated INR related to leg wound? That doesn't make much sense.

Usual cause of elevated INR without anticoagulants is hepatic failure/insufficiency because INR reflects vitamin K-dependent clotting.

In terms of a care plan, I'd assume the nursing diagnosis would be Risk for bleeding r/t elevated INR.

[angelcantrell1985]

Thanks for your help. What you're saying makes more sense that what Ive been reading.

[ckh23, BSN, RN]

Could be vitamin k deficiency. It's hard to say with the limited information. With a wound I might suspect possible DIC related to sepsis, but I would anticipate the patient being much more sick and have a diagnosis of sepsis. The patient could have underlying liver issues, etc.

[trishrnadm]

If the patient is on antibiotics for leg wound that will send INR wacky, usually elevating it to critical levels. That may be why the leg wound is mentioned.

[Esme12, ASN, BSN, RN]

Welcome to AN! The largest online nursing community!

Althought this thread is about 2 years old....That an excelent thought.....we are always learning!

[nurseprnRN, BSN, RN]

If the patient is on antibiotics for leg wound that will send INR wacky, usually elevating it to critical levels. That may be why the leg wound is mentioned.

What antibiotic does that? Source of this information?

And please...never, ever use the term "blood thinner."

Many people including, alas, physicians and nurses who know better, refer to anticoagulation medications (both antiplatelet and those acting on other parts of the clotting cascade) as "blood thinners." Unfortunately, and inaccurately, this puts people in mind of paint thinned by solvents or watered-down milk, or maybe thin, inadequate clothing. The problem then becomes that they are not aware of the actual physiological reason their medications are prescribed to reduce risk for embolic events, either stroke or deep vein thrombosis and pulmonary embolus. I have had patients tell me they are "always cold since taking that blood thinner." The risk of discontinuing the medication because the effects are inaccurately communicated is great, and very real. Anticoagulants do not "thin" the blood. They decrease blood clotting to decrease the chances of a clot in the heart from causing stroke or clot in a vein traveling to the lungs by preventing it from growing larger while the body's natural processes break it down for disposal. Side effects include easier bruising and bleeding. There, is that so hard?

[psu_213, BSN, RN]

What antibiotic does that? Source of this information?

I'm presuming what she meant is that the antibiotic will kill/inhibit the growth of bacteria, particularly in the large intestine, that produce Vitamin K. However, I have only heard of this being an issue (i.e. elevated INR) in the setting of warfarin use. Also, I think saying 'elevating it to critical levels' is a bit hyperbolic.

To the OP: how high was the INR?

[twopurpleskittles]

Was this pt septic? Severe sepsis will cause elevated INR also.