INR Too High/ Infection ?

I know infections infections affect the INR , but I can't remember which direction or by how much. ( I'm sure it's person to person dependent.)

I went from slight below target INR of 3.5 on Thursday to suddenly 4.5 this morning. ( spinach for breakfast!) Hematologist raised my Wafarin from 16mg every day to 17 mg every day starting Thursday morning. I am to self check Tuesday ( tomorrow) and report in with INR. I decided to check this morning. I've just switched a week ago today from LMW Heparin to Wafarin so we are trying to establish my dose.

I feel great with INR this high! ( I am leery to even report it to hematologist I feel so well! But that would not be fair to him... I'm about to call.)

However, I'm realizing in the last hour I very well may have a UTI. This may account for the higher INR.

Or, it could be both. I might have a slightly too high dose AND the onset of a UTI. I just don't want to lower my dose of Warfarin unnecessarily and reclot with a DVT the way I did last month...

So, which is it? Does an infectious raise the INR, or make it drop?

And... if I just ate about 1/2 cup of spinach, how long does it take for that to show effect on the INR?

22 Replies

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  • Also, Don't forget it takes warfarin a couple of days post dose to do it's job. If you call I would tell hematologist about poss UTI. I can't comment on if it raises or lowers because I honestly do not know. Good luck, please educate me, thanks, Cindy

  • Yes. It takes three days for max . A few more for steady state. Yes I told the RN Belia I had an Appointment with onbyn at at 1:30pm this afternoon and she might call Holahan if indeed it is a UTI.

  • Update: I just called my hematologist's office. ( my hematologist is Dr. Joseph Holahan in San Antonio, Texas for Reference. His nurse is a RN. I called her and reported. She said infections NEVER affect the INR in and of themselves. It's only the antibiotics that do. I had her repeat it to make sure I was understanding it correctly.

    Is this correct.

    Can any of Dr Beverly Hunts Patients weigh in on this please? Or any one here who actually and a true APS hematologist?

  • If I breathe my INR changes haha! I'm not sure what Drs generally think about whether infections change inr or not but I had a UTI last October and my inr went to 5.2 I think it was.

    However today I have no infection and I'm 5.4 - like I say most things I do seem to change mine!!

    Good luck x

  • Sorry to bother you, but can you pin point if the higher INR was due to the infect alone, or did it spike once antibiotics were commenced?

    Sounds like you are saying you just can't be sure...

    I sure wish the heparin would have worked in my case so this "warfarin warfare" as I call it could have been avoided...

  • You're not bothering me! I hadn't started the antibiotics- it was high the day I went to see dr about UTI. But I can't be sure it was the infection, as I say I'm high today with an infection. I've got a very unpredictable inr x

  • I'll let you know! I'm hoping folks here will let us all know!

  • Hi Kelly,

    It says here: Infection with fever will REDUCE the INR. I should not rely too much on it because it depends perhaps on other things also.

    Under it says that "illness" will INCREASE the INR!

    As to the spinach it must be individual but for me it takes around 15 hours to reduce my INR.

    I really do not know what to believe!'

    Kerstin

  • Oh wow. So many different reports it's hard to know. That's funny! Thank you for taking the time to look that up for me.

  • No wonder I couldn't remember/ was confused!

    ( great info on how long it takes to see an affect on one with vitamin k intake. Thank you. I have been wondering about that.)

  • I've just had the same thing (infected cyst) inr jumped to 5.2 but I felt amazing - fantastic - best ever!

    Going for a test today but as they lowered warfarin doseI expect it's lower now and I'm not that great any more 😞

    Good luck 💋

  • Hope they did not lower it too much- that razors edge we live on is too sharp to be comfortable sometimes. The problem is often it's the doctors comfort level he's/she's worried about...

  • U r so right Kelly, a good analogy I'm going to use it! 😂

    My inr had dropped to 3.6 so that explains the headaches.

    I had a struggle but finally he agreed to raise my warfarin dose!!! He wanted to leave it the same! I explained that it would have dropped more by next week and under 4 I feel terrible. Finally he agreed to raise it!!!

    How r u feeling? I hope the infection is sorted and inr stable. 💋

  • The initial urine sample run showed no infection. It's being sent off for a 3 day culture. I suspect it will be fine/ no infection. I did this once before- in January. I thought it was UTI- all clear. Then a couple of weeks later started spotting a little blood ( tiny amount) with urinating- thought maybe bladder? ) then a week later it was a little heavier- evident it was vaginal! I was totally confused because three years ago t had a hysterectomy, ecterocele, cystocele, ,and rectocele all at the same time. As it turns out I was " spitting a stitch" from the vaginal cuff. It did tear on out / come through in its entirety- one single permanent stitch. My gyno said very very unusual. The integrity of my tissue is just not right. I suspect APS and blood flow issues to tissues is to blame.

    I think perhaps I'm doing this again. Cramps, etc. it can feel confusingly like the bladder.

  • Sounds awful I hope they sort it out soon hugs 🤗 Xx

  • I have had 18 episodes of bronchitis/ pneumonia in last 3 years due to the immune deficiency I have along with APS. For me, the infections did not affect my INR. However, most antibiotics, the ones I tolerate anyway, run my INR sky high. When on antibiotics I've learned to cut my Coumadin by 1/2 and check INR a day or two later. Immune deficiency (CVID) now being treated with IVIG so have not needed antibiotics for almost 5 months!

    Another odd problem that wreaks havoc on INR is diarrhea. It has caused my INR to jump to 7. But, even at 7 I cannot totally stop Coumadin even for one night cause my INR drops like a rock. My hematologist stopped my Coumadin for one night when my INR was 7 and the next morning my INR was 2.3 and my blood clotted in tube before it reached the lab. ( I was hospitalized when this happened). Needed emergency injection of lovenox.

    Now I know if I get a really high reading on INR, especially with diarrhea, I cut my usual dose in half.

    You live and learn.

    Nancy in West Virginia

  • Thank you so much for this feed back. I was left winging it on my own the evening my INR was high. ( this is the first time it has ever been too high. Usually it just keeps tanking. )

    My hematologists nurse never called me back with instructions Monday. ( she still hasn't I might add- even though I took my INR again yesterday with my coagucheck I have at home and it was down from 4.5 to 3.4, and this morning it's slightly low with 3.0)

    So my dose was 17 mg daily- I had just begun that from 16 mg daily for 4 days and was 2.7 I think so he upped it to 17 every day and it shot me to 4.5. ( target 3.5 " at least" per Professor Hughes.)

    I didn't know what to do so I just took 6 mg that night.

    Called nurse yesterday ( with updated Inr of 3.4) and told her what I had done the previous evening for dosing since I hadn't heard back, explained I didn't think it was wise to play the part of my own hematologist, and could I please have guidance moving forward on re- establishing doseing.

    Still have not heard from his office.

    I took 15 last night

    I plan to take 16 tonight.

    I guess I'm now my hematologist.

  • I have had 3 bouts with Dehydration And Diarrhea , little to no urination ,I was hospitalized and received 2 large IV bags every time and and INR shot up- This may very well be because of the dehydration from severe diarrhea.I had Dia. 17 times is 12 hour what ever i drank ran right thru me . So Dia. and low hydration with me made my INR go up 2 .0 points.

  • My goodness. 17 times in one hour. That'll keep a guy busy...

    Before my diagnosis I kept going into paralytic ileus. ( now we know it was micro clotting into bowels.) In and out of multiple surguries looking for adhesions... but appendix was chronically infected- it had to go. Gall bladder quit squeezing. No stones- just quit working. It had to go. Likely all the ileuses just took their toll on these various systems. organs and glands don't like to be infected/ sluggish/ from being in paralytic ileus. Lots and lots of diarrhea and vomiting. Lots of hospitalizations for being waaaay too thin. I totally get it. No fun. Very dehydrated.

    Thanks for letting me know. Now I will have a heads up on this.

    Hope you and Casey are doing ok in... Vermont?

  • I believe he is in New Hampshire🌵Kelly

  • 12 hour period Kelley-- and and Witt is correct Casey and I live in N.H. one state over Close though HA

    Thanks Witt

    Hot up here today , they expect 90 degree's today -- way to hot for me and i am not suppose to be in Direct sun .

  • So culture was negative ?

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