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What to Do When Your INR Is Too High


About this topic


You are taking a blood thinning drug to help manage a disease. These drugs keep blood from clotting inside the body. It is important that you do not have too much or too little of the blood thinning drugs in your body. Doctors use a blood test, called the INR or International Normalized Ratio, to check how quickly your blood clots. The staff will take a small amount of blood for this test. They will either prick your finger or take blood from a vein using a syringe. ‚  
The higher the INR, the more time it takes for your blood to clot. For some conditions, the doctor wants your INR high, but if it gets too high, you are at risk for bleeding. You may see some signs if your INR is too high and needs treatment. You may: ‚  
  • Bruise easily or have bruises that are not healing
  • Have bleeding gums
  • Have blood in the urine, stool, or vomit
  • Cough up blood
  • Have nose bleeds
  • Bleed from cuts and it does not stop with pressure over the cut
  • Have heavy menstrual bleeding or a period that lasts much longer than usual

Bleeding as a result of too high an INR should be treated right away. Treatment will depend on how much bleeding you have and the value of your INR. Your drugs will need to be adjusted or changed. ‚  

What care is needed at home?


  • Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
  • Take your drugs as ordered by your doctor.
    • Make sure you take the right amount of drugs and follow the correct schedule.
    • If you are taking blood-thinning drugs, ask your doctor if there are other treatments or drugs that you can take.
    • Learn about other drugs that raise your risk for bleeding. Dont take these drugs unless you check with your doctor.
      • Aspirin
      • Ibuprofen, such as Advil or Motrin
      • Naproxen, such as Aleve or Naprosyn
      • Celebrex
    • Always check with your doctor or pharmacist any time a drug is added, stopped, or a dose is changed.
  • Protect yourself from bruising and bleeding.
    • Avoid injuries or places where you could be bruised, cut, hurt, or fall.
    • Stay away from or be careful with sharp objects such as wet razors or fingernail clippers.
    • Brush your teeth gently. Use a toothbrush with soft bristles.
  • If you start to bleed:
    • Put a gauze pad over the area and apply pressure until the bleeding stops. This will take several minutes longer than usual because of the blood-thinning drug.
    • Do not use a tourniquet by tying something around the area. Only do this if you have cut an artery or vein and blood is spurting out fast.

What follow-up care is needed?


  • Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
  • Your doctor will order more INR tests to check your condition.
  • Your doctor may also order urine and stool tests.
  • Tell ALL your doctors, dentists, nurses, and pharmacists that you are taking a blood-thinning drug. Carry a card in your wallet or wear a MedicAlert bracelet or necklace. This will help others know to not order a drug that interacts or adds to the blood-thinning drug you are taking.

What drugs may be needed?


The doctor may order drugs to help stop bleeding. ‚  

Will physical activity be limited?


You may have to limit your activities to avoid injuries. Talk to your doctor about the right amount of activity for you. ‚  

What changes to diet are needed?


Ask your doctor or dietitian if there are foods you should not eat. ‚  

What problems could happen?


  • Lots of uncontrolled bleeding
  • If large amounts of bleeding are not controlled, your organs inside could fail.

When do I need to call the doctor?


  • Report any falls or blows to the head, even if you feel fine. Go to the emergency room to be checked if you are not able to reach your doctor.
  • If your vomit is bloody or looks like coffee grounds, go to the emergency room if you cant reach your doctor.
  • Cuts or wounds with bleeding that cannot be controlled with pressure.
  • Bruising more easily than usual
  • Gums won't stop bleeding with each brushing
  • Pink or reddish-brown color in the urine
  • Bowel movements that are red or black like tar
  • Nose bleeds that won't stop with pressure put on the nose
  • Confusion, feeling dizzy or faint, unusual headaches

Teach Back: Helping You Understand


The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing. Before going home, make sure you are able to do these: ‚  
  • I can tell you about my condition.
  • I can tell you how I will take my blood thinners and what I will do to protect myself from bleeding.
  • I can tell you what changes I need to make with my diet, drugs, or activities.
  • I can tell you what I will do if I fall, have bleeding that will not stop, or have too much bruising.

Where can I learn more?


American Heart Association ‚  
http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300338.pdf ‚  
http://circ.ahajournals.org/content/119/8/e220.full ‚  
Heart Rhythm Society ‚  
http://www.heartrhythmfoundation.org/a-fib/INR_FINAL.pdf ‚  

Consumer Information Use and Disclaimer


This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. ‚  

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