Sudden spike in INR after change in mental status

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I work in long term care and I have a resident who has had a change in mental status and has seriously declined in the past couple of weeks. It started with what seems like acute delirium then continues with increased confusion, aphasia, mood swings and uncontrollable emotions. She has also gone from nearly independent with a walker to completely dependent with extensive two assist. She's treated with Coumadin (always has been) and is regularly stable until today. She's been on 2.5 of Coumadin and INR spiked from 2.09 to 6.01 in a week. No medication changes. No diet changes. Any suggestions or input??

Specializes in Anesthesia, ICU, PCU.

This patient needs a lot of radiation shot at her head from different angles like... yesterday. If the family wants a confident answer, then they have to accept a diagnostic workup that inspires confidence

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Just to follow up with everyone who responded. The woman was sent to the hospital last week (finally) due to delirium continuing to get worse. She was found to have an interventricular hemorrhage d/t what we do not know. She is back in the nursing home and has markedly declined and seems like she will continue to do so.

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