Sticky Blood-Hughes Syndrome Support
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INR shoot up

Looking for advice. My INR range is 2-3.

I was due to have a tooth out last week but they wouldn't do it as my INR was 3.4. Had a blood test yesterday and the anticoagulation nurse has just rung to say its 4. and told me to reduce my warfarin from 22mg to 18mg.

Should I be worrying and any suggestions what I can do to lower it.

I had a 7 day course of antibiotics but finished them about 10 days ago apart from that my meds and diet haven't changed.

12 Replies

I hope this settles down for you, maybe it is your body coming back into line after antibiotics and reason for them, other than that, i will leave this to those with more INR expertise.. only myself being an aspirin baby! Mary F x


In my experience, it's not abnormal for the INR to fluctuate quite a bit, especially after taking other medication. If it were me, I would eat a little extra food containing vitamin K, like spinach or broccoli, to help it reduce. Also, the reduction in your Warfarin intake prescribed by your doctor will reduce the INR. The main thing we need to do to keep the INR stable is to keep our diets (including everything we ingest) as consistent as possible.


Thanks for the response have to go and get some broccoli and see if that does the trick.


I have always found that my INR increases when I have been on anti biotics. It also increases if I am eating less, or in my case eating a lot of vegetables/salads.

I always thought that to eat more broccoli would possibly send it higher.

I dont want to cause confusion. So if I am wrong I would like to be corrected.


If your INR ever tested at a possibly dangerously high level for you, you'd probably be given vitamin K to bring it down. Consequently, foods containing vitamin K reduce your INR rather than raising it. I hope this helps you and clarifies things for you! John.


With regard to the dental part of your question, it's important for any future dental work you may need that you get the tooth, the whole tooth and nothing but the tooth. (Sorry!)

Dentists may have differing policies or opinions on INR and it might be useful to you to ask what your dentist's is. For example, my dentist won't work with an INR above 4.0.

Also, ask your GP to refer you to a Special Care Dentistry unit that treats haemophiliac patients as they will most likely also treat patients on warfarin. You may find that you're entitled to this care without charge through the NHS.

Below are some very reassuring patient histories and policy that you might like to draw to the attention of your dentist and GP. Good luck! John.


The site has foreshortened the last url:

( info/warfarin.pdf )

It's a pdf so when you click on it, it will download so you can read it with Adobe Reader or whichever pdf reader you use. If you don't have Adobe Reader you can Google and download it for free. Sorry if this is teaching you to suck eggs. The content is well worth reading! John.


I lowered mine overnight for a tooth extraction from 4.0 to 1.6 by eating a small container of broacholi beef. Measured by a lab.


Hi Zezes-nan,

If you reduce your warfarin and also eat broccoli it can be too much. We are all different but it can be dangerous to change things in a short time. K-vitamin vegetables usually reduce Warfarin faster than a reduction in Warfarin does. Personally, but I have Lupus Anticoaculant, would never change both tablets and K-vitamin rich vegetables at the same time.

Ask your doctor or the anticoaculant clinic for advice! Kerstin


I've lifted this from a different question on the site (as below) because I think it might be relevant and interesting:

Update on Extractions

Posted by lovemyheart

5 days ago


I went to the oral surgeon yesterday and had two teeth pulled. I was scared because i wasnt able to be put out due to my heart. I just had novacaine and i didnt feel a thing just pressure. The dr was fantastic. He used a collagen gel foam he stitched in there so i wouldnt bleed. I had no problems just soreness afterwards. However, i started today taking Amicar for bleeding and developed a horrible headache. My hematologist wasnt in so i didnt take the next dose. I hope im doing the right thing but ive had this headache twelve hours already so i will speak to him tomorrow. Im on aspirin for the hughes which i took. The amicar is only for ten days, but the headache scares me

In a related fashion, the piece below comes from the University of Dundee (source same as the warfarin/dental pdf earlier). Compare above: "He used a collagen gel foam he stitched in there so i wouldnt bleed." with the first sentence below and in particular "collagen sponge (Haemocollagen®)".

Local haemostasis Sockets should be gently packed with an absorbable haemostatic dressing, e.g. oxidised cellulose (Surgicel®), collagen sponge (Haemocollagen®) or resorbable gelatin sponge (Spongostan®), then carefully sutured. Haemostatic dressings promote and stabilise clot formation by providing a mechanical matrix. Trials in patients who have continued anticoagulant therapy throughout the perioperative period have used resorbable (catgut or synthetic (polyglactin, Vicryl®)) or non-resorbable (silk, polyamide, polypropylene) sutures. Resorbable sutures are preferable as they attract less plaque. If non-resorbable sutures are used they should be removed after 4-7 days. Following closure, pressure should be applied to the socket(s) by using a gauze pad that the patient bites down on for 20 minutes.

Your dentist may very well be interested in seeing this too and perhaps using these techniques on you and others! John.


Thanks for all the answers, John I've been referred to the maxi facial surgeons at my local Hospital rather than my usual dentist.

The one I saw was very switched on about warfarin but hadn't heard of Hughes (surprise surprise) he told me he would stitch it before I even sat down.

So it looks like weekly INR's until I get the next appointment.


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