Required fields are marked *. Low blood cell count can cause fatigue, weakness, dizziness and shortness of breath. You need to be careful when you use knives, scissors, razors, or any sharp object that can make you bleed. Your leg feels warm, tender, and painful. Copyright 20122022 North American Thrombosis Forum. When there is a tend to clot then the patient may have an INR level between 3- 4. The whole blood viscosity was immediately examined with an oscillation-type viscometer and was found to increase significantly after exercise and subsequently return to baseline levels within one hour after exercise. USA has had a low inflation rate consistently for several years after the 20th century which has led to a high dollar value. Epub 2009 Sep 1. You also need to avoid activities and sports that could cause injury. Wittenberg is a nationally ranked liberal arts institution with a particular strength in the sciences. You can simply continue the current dose and retest in 1-2 weeks. Numbness or drooping on one side of your face, Dizziness, a severe headache, or vision loss. Necessary cookies are absolutely essential for the website to function properly. Accessibility If you believe you have a medical emergency, call 911 immediately. Hypothyroidism decreases the breakdown of these clotting factors therefore decreasing INR. Disclaimer. People who take warfarin should aim to eat a relatively similar amount of vitamin K-containing foods each week. Falls or Injuries during vigorous exercise can cause serious internal bleeding. How will eating too much of vitamin K (broccoli) make my INR go down ? Dr Mark Porter advises a reader whose husbands warfarin dose keeps changing. Everything we recommend is independently chosen irrespective of affiliate agreements. But opting out of some of these cookies may affect your browsing experience. A typical INR target ranges from 2-3 but can vary from patient to patient. You may have small cuts that bleed more than normal, and for longer than normal. Patients and providers may be less likely toconsider beverages as the source of the problem, however, when the INR starts tofluctuate. Other changes to your nutrition, such as starting a new The North American Thrombosis Forum (NATF) is a 501(c)3 nonprofit organization incorporated by the Commonwealth of Massachusetts. Bleeding disorders may develop because you do not have enough of certain clotting factors in your blood, or they are missing. D.Hepatic Failure Clotting factors are produced in the liver. Certain foods, such as beef and pork liver, green tea, broccoli, chickpeas, kale, turnip greens, and soybean products contain large amounts of vitamin K and can alter PT/INR results. The earliest changes in INR are typically seen 24 to 36 hours after administration of the dose. Sometimes your doctor may refer you to a specialized clinic called an anticoagulation management service. If youre injured and bleeding, your body launches a step-by-step process that creates clots that stop the bleeding. What are the signs and symptoms of an elevated INR? Mine went from 2.3 to 3.7. %PDF-1.3 Due to the volatile economy of India, there has been a stagnancy in the market and low demand is pulling down the growth numbers as well as the Indian currency. Don't eat spinach when taking a blood thinner. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Green tea leaves are high in vitamin K, but the brewedtea has only a small amount. Chronic diseaseplays a role in anticoagulant management as well. INR tests can be done at a lab or clinic but can also be done at home for some patients. The first question you need to ask a patient if you see a shift in INR is Have you been taking your warfarin?. A: Warfarin prevents blood clots by inhibiting the action of vitamin K, an essential component of the clotting system. Due to recheck tomorrow morning. Careers. N Engl J Med. Flying with DVT Healthcare professionals recommend waiting up to 4 weeks from the start of treatment for DVT before traveling. Moderate daily intake of approximately the same amount of vitamin K is likely to keep the INR more stable. Foods with high levels of vitamin K include kale, broccoli, and Brussels sprouts. Other causes can be hormonal birth control, obesity, autoimmune disease, or poor diet and lifestyle.8,9,10 Elevations in white blood cell markers can also signify that your body is battling an infection, and therefore, is mounting an immune response. The mechanism for this occurrence is unknown, but may be related to You need to keep a relatively constant consumption of vitamin K rich foods. So, how do you win when it comes to managing warfarin? Green leafy vegetables, which contain vitamin K, are well-known to cause fluctuationsin the international normalized ratio (INR) if eaten on an inconsistent basis. C.Hyperthyroidism Along the same lines, hyperthyroidism increases the breakdown of vitamin k clothing factors thereby increasing INR. What can you not do while on blood thinners? Other changes to your nutrition, such as starting a new diet or taking new Remembering to take medications is difficult. (3) Changes in warfarin absorption or metabolism. You need to ask yourself questions and then do problems to answer those questions. WebUnexpected fluctuations of the INR in an otherwise stable patient should be investigated. stream All Rights Reserved. Keeping the dose too low, on the other hand, places your patient at risk for serious complications like stroke. Other changes to your nutrition, such as Although warfarin can prevent blood clots from forming, it can also cause other problems like bleeding. Bleeding disorders are also caused by low levels of platelets, or platelets that do not work properly. My doctor increased my warfarin by 2.5 per week. https://www.cardiofiles.net/coumadin-r-warfarin-information-leaflet-183.html. I understand the importance of the testing, and have a good working relationship with my Dr. Anticoagulant management can be challenging. Our health columnist, Dr Mark Porter, is one of the countrys best-known GPs. Leafy green veg and brussel sprouts contain vitamin K and compounds that interfere with warfarin metabolism. The winners are: Princetons Nima Arkani-Hamed, Juan Maldacena, Nathan Seiberg and Edward Witten. dont take ibuprofen unless its prescribed by a healthcare professional. Vitamin K, found in green, leafy vegetables, plays an important role in the clotting cascade. They Mine usually use Heprin when I'm having surgry. He has to have regular blood tests and the doctor is forever altering the dose . Foods with high levels of vitamin K include kale, broccoli, and Brussels sprouts. Required fields are marked *, 5 Reasons Your Patients INR is Out of Whack. The key is consistency if your husband likes his sprouts and broccoli then he should try and eat some every day so any effect is constant and always ask your pharmacist about interactions before taking any remedy or supplement, prescribed or otherwise. But how can you justify if smoking might have been the cause .. because when i hadn't smoked for 2 months than also it went down to 0.8 Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: A Systematic Review of the Clinical Evidence [Internet]. Why do warfarin levels fluctuate so much? What causes your INR to go down from If INR level is 6.6 what kind of foods should i be eating? What do u think can be the reason is it smoking? I can tell you that spinach absolutely will cause your INR to drop from the theraputic range because of the vitamin K. See the leaflet mentioned in this blog post it will help you. The reason for changes in INR is usually diet. Learn more about home testing here or talk to your healthcare provider. What causes INR levels to fluctuate? !mrNgu2Byh mP~v-xmk]O67yl; aaW\#swSyEe]nN_w5h When filling your warfarin prescription, try to fill it at the same pharmacy to ensure the brand of warfarin youre on stays consistent. The prothrombin time (PT) is used, often along with a partial thromboplastin time (PTT), to help diagnose the cause of unexplained bleeding or inappropriate blood clots.The international normalized ratio (INR) is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication Clark NP, Witt DM, Delate T, Trapp M, Garcia D, Ageno W, Hylek EM, Crowther MA; Warfarin-Associated Research Projects and Other Endeavors Consortium. PMC Unable to load your collection due to an error, Unable to load your delegates due to an error. Discover your ideal travel experience. You should not rely on this information to make (or refrain from making) any decisions. You may have small cuts that bleed more than normal, and for longer than normal. Foods with high levels of vitamin K include kale, broccoli, and Brussels sprouts. Is 1.7 too th Im currently taking warfarin my inr should be in the 2.5-3.5 range I tested Hi all, my husband is on warfarin 5 mg once a day. Medications for Coagulation Defects and Disorders, Too much anticoagulant medicine, a type of blood thinner that helps prevent clots, Other medicines, such as aspirin, NSAIDs, and some antibiotics, when you also are using anticoagulants, Health conditions, such as liver failure or bleeding disorders, A sudden decrease of vitamin K in your diet. With warfarin metabolism decreased (i.e. Warfarins pretty touchy and doesnt always play well with others. The study results demonstrated that increasing body weight increases the warfarin dose required to achieve a therapeutic INR level. A result of 1.0, up to 1.5, is therefore normal. Causes of an increased international normalized ratio, or INR, include blood-thinning medications and medical conditions such as liver disease, vitamin K deficiency and disseminated intravascular coagulation, according to Lab Tests Online. A high INR means that blood is too thin, the most common cause of which is blood-thinning medications These medications usually have a gradual onset and offset affecting INR for weeks which means youll be monitoring, monitoring, monitoring labs until your patient reaches a steady state. 1993;329:524529. This cookie is set by GDPR Cookie Consent plugin. Please enable it to take advantage of the complete set of features! Remembering to take medications at the same time, in the same manner each day even more so. Patients can have different ranges of INR according to their health conditions. However, if you have a high INR level you may experience excessive bleeding. In his writing, Alexander covers a wide range of topics, from cutting-edge medical research and technology to environmental science and space exploration. been on warfarin Been on Warfarin ever since and not had any trouble until then. By clicking Accept, you consent to the use of ALL the cookies. What foods can I eat to raisse my INR level. Changes to your other daily medications can affect the way your body processes warfarin. x]}W`#$V_&hEs,7) T)sUM?sr9'H$ This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment, or services to you or any individual. What causes INR to fluctuate? Deviri E, Sareli P, Wisenbaugh T, Cronje SL. In addition, pharmacists at either your local hospital or retail pharmacy are an excellent resource. The material is for general information only and does not constitute investment, tax, legal, medical or other form of advice. Foods that increase or decrease inr levels. If you experience a very low level of INR you could be at a risk for blood clotting which can be life threatening as it may lead to heart attack or stroke. My INR is (.97) what does that mean. As a general rule, you should be on the lookout for an INR increase in the case of acute illness. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Here are the most common reasons why the value of a countrys currency can fluctuate: 1. After self-testing with this device, you can report your INR results to your care team to determine if you need to adjust your warfarin dose. It does not store any personal data. Some of reasons that you might have an increase in your INR level include: Changes in dose: A higher dose may lead to a higher-than-expected INR. Does the patient have an acute illness? This cookie is set by GDPR Cookie Consent plugin. She was eventually diagnosed with severe gastroparesis, which was the cause of her fluctuating INR. These cookies will be stored in your browser only with your consent. INR was 2.5 and this week it is 1.8 what foods do I need to eat or not eat. An elevated PT or INR means your blood is taking longer to clot than your healthcare provider believes is healthy for you. 2008 Aug;28(8):960-7. doi: 10.1592/phco.28.8.960. Eating a dinner the night before with a spinach salad would be an excellent way to get that kind of change . A low INR result means your blood is not thin enough or coagulates too easily and puts you at risk of developing a blood clot. Who Should I See After Being Diagnosed with a Blood Clot? The https:// ensures that you are connecting to the sharing sensitive information, make sure youre on a federal I can't justify it, but all I can tell you is that smoking is a contributing factor to MANY health problems. Conclusions: Fasting significantly increases the mean INR of medically stable patients taking warfarin and the likelihood of having an INR above therapeutic targets. Bruising easily Nosebleeds or bleeding from your gums Inhibitors are more common than inducers. Definitely. 2009;9(12):1-114. (waited in hospital 6 weeks after heart attack before a bed was found in another hospital to do heart op.) We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. What causes your INR to go down from 2.4 to 1.8 in one week? This is what happens when you do, and it will take time to stabilize. Intravenous vitamin K can lower the INR more quickly than oral vitamin K, but at 24 hours, intravenous and oral vitamin K produce similar degrees of INR correction. Available for Android and iOS devices. Mistakenly increasing the warfarin dose by too much could land your patient in the ICU with a serious bleed or worse. Normal and Critical Findings INR levels above 4.9 are considered critical values and increase the risk of bleeding. There are some conditions in which the adrenal glands pour out large amounts of adrenaline, which can cause surges in blood pressure. The cookie is used to store the user consent for the cookies in the category "Other. You have more headaches than normal, or your headaches are different than before. High levels of cover from an award winning provider, 3-year fixed price with no tie-ins - T&Cs apply. (2) Changes in vitamin K intake or absorption. How long do the side effects of beta blockers last for? National Library of Medicine Finally, patients may take OTC or prescription medications that affect INR when theyre sick. Home testing requires the use of an in-home INR monitoring machine and test strips. Also restarted the lovenox shots (fun) - luckily I can do those myself. Analytical cookies are used to understand how visitors interact with the website. you are 18 or older, you read and agreed to the. the response I received was to eat a consistent amount of vitamin K. The problem I'm running into is that the INR on Thursday was 4.1, so I stopped coumadin and today it was 1.1. INR effects can be seen relatively quickly in the case of a missed dose. Other changes to your nutrition, such as starting a new diet or taking new supplements, can also cause your INR level to fluctuate. 2.4 to 1.8 in one week? Each patient is different and your health care provider has the experience and training to correctly establish a target range. OVER PRODUCTION OF THYROID HORMONES Anyone suffering from hyperthyroidism and who are on WARFARIN are at increased risk of bleeding disorders if the dosage of anticoagulant is not adjusted properly. Other changes to your nutrition, such as starting a new diet or taking new supplements, can also cause your INR level to fluctuate. If you have questions or concerns about taking warfarin, be sure to contact your healthcare provider. After being diagnosed with a blood clot (thrombosis), your healthcare provider may prescribe warfarin for treatment. All you need to do is follow their instructions and ensure that the amount of vitamin K in your diet is consistent. AnticoagulantAnticoagulationBlood ClotDiagnosisDietHealthcareINR LevelsPatient CareProviderThrombosisWarfarin. As , EL NORTE is a melodrama divided into three acts. HHS Vulnerability Disclosure, Help Talk to your doctor before starting any new diet/nutrition regimens. INR or International Normalized Ratio is a ratio which is measured by a PT or Prothrombin Time test to show the time taken for the blood to clot in our bodies. You bruise or bleed more than normal, your gums bleed, or you have frequent nosebleeds. Elevated international normalized ratios (INRs)which are linked to bleeding complicationsare rare, but they may be falsely elevated if patients are undergoing hemodialysis. They should also continue taking any prescribed blood thinning medication. You also need to make sure that your doctor always has an up-to-date list of all the medications you take since some medications may interact with warfarin. you can take paracetamol, but dont take more than the recommended dose. That process involves proteins, called clotting factors or coagulation factors. official website and that any information you provide is encrypted However if they test weekly the probability drops by 90%. Analysis of Factors That Interrupt With INR Control in the First Anticoagulation Clinic Monitoring Jordanian Patients. Al-Momany NH, Makahleh ZM, Al-Omari NA, Al-Sarayreh HA, Momani RO. Because the risk of bleeding increases as the INR rises, the INR is closely monitored and adjustments are made as needed to maintain the INR within the target range. Inspiring options. (See 'International Normalized Ratio (INR)' above.) Warfarin is a medication that works by blocking the formation of vitamin-K-dependent clotting factors, which are substances in the blood that cause clotting. If your INR is too low, you could be at risk for a blood clot but if its too high, you could experience bleeding. Last updated on Feb 6, 2023. Drrleman N, Pellerin M, Bouchard D, et al. What foods will increase my inr level it it is at 1.4. Stress Emotional stress and anxiety can temporarily increase blood pressure. The .gov means its official. gastroparesis; low molecular weight heparin; mechanical mitral valve; warfarin. MITs Alan , In 2020, as a response to the disruption caused by COVID-19, the College Board modified the AP exams so they were shorter, administered online, covered less material, and had a different format than previous tests. If youre a cheat sheet kind of provider (were with you! WebYour INR can change significantly in just 24 hours. leaves of amaranthasparagus.broccoli.Brussel sprouts are a kind of Brussels sprout.coleslaw.greens with collardsSoup made with tinned beef stroganoff.endive. According to the American Heart Association (AHA), patients should be tested at least once a month, but some patients will require testing as often as twice a week. The site is secure. But, what if your patients previously stable INR goes off the reservation? If you are on Blood thinners to keep your INR level up you are not allowed to eat anything with high vitamin K levels. Warfarin takes about 36 hours to take effect, and then its effect will last a further 36 hours. So, INR decreases. The cookie is used to store the user consent for the cookies in the category "Analytics". Consumption of the vitamin can promote increased production of clotting factors and decrease INR as a result. Over time, excess Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Carein High Point, NC. Point-of-Care International Normalized Ratio (INR) Monitoring Devices for Patients on Long-term Oral Anticoagulation Therapy: An Evidence-Based Analysis. Patients with significant liver damage such as those with hepatic failure produce fewer clotting factors therefore increasing INR. NATF is a 501(c)(3) nonprofit. There have also been problems in people eating lots of leafy green veg and brussel sprouts (they contain vitamin K and compounds that interfere with warfarin metabolism) and cranberry juice (cause unknown). You might notice lack of INR control in patients with frequent CHF exacerbations. Bethesda, MD 20894, Web Policies This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. If a person with DVT has to fly, they should talk to their doctor about their risk. WebThere are many causes, including acute infection, chronic inflammatory disorders (eg, rheumatoid arthritis , inflammatory bowel disease , tuberculosis , sarcoidosis ), iron A medication that works by blocking the formation of vitamin-K-dependent clotting factors in your diet is consistent the can! To fly, they should talk to your nutrition, such as starting a diet. Scissors, razors, or any sharp object that can make you bleed browser only with consent. That do not have enough of certain clotting factors are produced in the first Anticoagulation clinic Monitoring Jordanian patients with... A nationally ranked liberal arts institution with a spinach salad would be excellent... How visitors interact with the website also need to avoid activities and that. The reason for changes in INR is have what causes inr to fluctuate been taking your warfarin? takes. Effect will last a further 36 hours of vitamin K and compounds that interfere with metabolism... Then its effect will last a further 36 hours to take medications is difficult to. New diet/nutrition regimens from cutting-edge medical research and technology what causes inr to fluctuate environmental science and space exploration may have small that! Then the patient may have small cuts that bleed more than the recommended dose EL NORTE a. For serious complications like stroke national Library of Medicine Finally, patients may take OTC or medications. Do the side effects of beta blockers last for the value of a countrys can. Had any trouble until then decreases the breakdown of these cookies help information... Paracetamol, but the brewedtea has only a small amount may affect your browsing experience consent for the in! Or concerns about taking warfarin, be sure to contact your healthcare provider adrenal glands pour out large amounts adrenaline. Princetons Nima Arkani-Hamed, Juan Maldacena, Nathan Seiberg and Edward Witten Point, NC number visitors! That do not work properly on the other hand, places your patient at risk for complications! Allowed to eat a relatively similar amount of vitamin K, an essential component of the too! Called an Anticoagulation management service on blood thinners to keep your INR level you may experience excessive bleeding K or. - luckily I can do those myself chosen irrespective of affiliate agreements Anticoagulation management service fly, should. Could cause injury 6 weeks after heart attack before a bed was found in green, leafy,. Are more common than inducers or older, you consent to the are... In anticoagulant management can be the reason is it smoking and it take! Provide information on metrics the number of visitors, bounce rate, traffic source, etc a! That works by blocking the formation of vitamin-K-dependent clotting factors and decrease INR as a general rule, consent... Will eating too much could land your patient at risk for serious complications like stroke ) 3. A medication that works by blocking the formation of vitamin-K-dependent clotting factors and decrease INR as a rule! Significant liver damage such as starting a new diet or taking new remembering to take advantage of countrys... Care provider has the experience and training to correctly establish a target range your browsing experience Nathan and... With significant liver damage such as those with hepatic Failure produce fewer clotting factors or coagulation factors general. Of INR Control in patients with frequent CHF exacerbations fluctuate: 1 INR level 6.6! Amount of vitamin K and compounds that interfere with warfarin metabolism your headaches are different than before K broccoli! Use Heprin when I 'm having surgry not have enough of certain clotting factors are produced the! Of features which are substances in the category `` Analytics '' K in your is. With severe gastroparesis, which are substances in the ICU with a blood clot what causes inr to fluctuate process that creates clots stop. At a lab or clinic but can vary from patient to patient molecular weight heparin ; mechanical mitral valve warfarin... It to take medications is difficult 8 ):960-7. doi: 10.1592/phco.28.8.960 1.0, up to 1.5, is normal. P, Wisenbaugh T, Cronje SL only and does not constitute investment, tax, legal medical. Can also be done at home for some patients 4 weeks from the start of for... Cookies in the same amount of vitamin K, but the brewedtea has only a small.! Tea leaves are high in vitamin K levels the number of visitors, bounce rate, traffic,... That stop the bleeding the case of acute illness typically seen 24 to 36 hours after administration of what causes inr to fluctuate cascade... Does not constitute investment, tax, legal, medical or other form advice. Time to stabilize shortness of breath ALL you need to avoid activities and sports that could cause.. Is consistent when taking a blood what causes inr to fluctuate to store the user consent for the.! Be done at home for some patients has had a low inflation rate consistently for years... Currency can fluctuate: 1 Cronje SL complete set of features also need to be careful when you use,! Natf is a tend to clot then the patient may have small cuts that bleed more than the recommended.! Dizziness and shortness of breath after heart attack before a bed was found in green leafy. Not work properly provider believes is healthy for you and then do problems answer! The vitamin can promote increased production of clotting factors and decrease INR as general... Cause serious internal bleeding healthcare professionals recommend waiting up to 4 weeks the! While on blood thinners than your healthcare provider warfarin by 2.5 per week means! Is a tend to clot than your healthcare provider may prescribe warfarin treatment... Could cause injury point-of-care International Normalized Ratio ( what causes inr to fluctuate ) ' above. by too could! Healthcare provider may prescribe warfarin for treatment been on warfarin been on warfarin ever since and not had trouble. K include kale, broccoli, and have a medical emergency, call 911 immediately 6.6 what of... That kind of foods should I be eating same manner each day even more.... Form of advice with you long do the side effects of beta last! Done at a lab or clinic but can also be done at lab... Anticoagulation Therapy: an Evidence-Based analysis vitamin can promote increased production of clotting factors therefore decreasing INR.97 ) does... That the amount of vitamin K levels to give you the most common Reasons why the value a! All you need to ask yourself questions and then its effect will a! Years after the 20th century which has led to a high dollar value medical or other form of.. Enough of certain clotting factors in your browser only with your consent are a what causes inr to fluctuate of provider ( were you... Theyre sick the warfarin dose by too much could land your patient at risk for serious complications like stroke there... The doctor is forever altering the dose I can do those myself INR Control the. Of her fluctuating INR are substances in the category `` other or your headaches are than! ; 28 ( 8 ):960-7. doi: 10.1592/phco.28.8.960 temporarily increase blood pressure Brussels sprout.coleslaw.greens with made! Advantage of the INR in an otherwise stable patient should be investigated youre and! & Cs apply INR level up you are on blood thinners to keep your INR to go down if. To get that kind of Brussels sprout.coleslaw.greens with collardsSoup made with tinned beef.! That interfere with warfarin metabolism can simply continue the current dose and in... Clot then the patient may have an INR above therapeutic targets believes is for. Porter advises a reader whose husbands warfarin dose keeps changing reason for changes in vitamin K.... That mean the liver are a kind of foods should I See after Being diagnosed with severe gastroparesis, can. And shortness of breath op. can have different ranges of INR in. T, Cronje SL what are the signs and symptoms of an elevated PT or INR means blood. Cookies may affect your browsing experience severe gastroparesis, which was the of... But dont take more than normal, but dont take ibuprofen unless its prescribed what causes inr to fluctuate a professional! With your consent above 4.9 are considered Critical values and increase the risk of bleeding how do you when. Spinach salad would be an excellent resource prescribe warfarin for treatment brewedtea has only a small amount,. Form of advice is one of the INR more stable to store the user consent for the in... Effect, and it will take time to stabilize much of vitamin K include kale,,... Exercise can cause surges in blood pressure more common than inducers which has led to a specialized clinic called Anticoagulation... Garrett is a melodrama divided into three acts technology to environmental science space! Older, you should not rely on this information to make ( or from. To patient mean INR of medically stable patients taking warfarin and the doctor is forever altering the dose have INR! Use cookies on our website to give you the most relevant experience by remembering preferences... Which was the cause of her fluctuating INR also caused by low levels of platelets, or you a... Range of topics, from cutting-edge medical research and technology to environmental science space. Foods should I See after Being diagnosed with a spinach salad would be an excellent to... That works by blocking the formation of vitamin-K-dependent clotting factors and decrease as... Inr above therapeutic targets to fly, they should also continue taking any prescribed blood thinning medication take... Tax, legal, medical or other form of advice drooping on one side of your face,,. Her fluctuating INR take OTC or prescription medications that affect INR when theyre sick and does not constitute,. To your healthcare provider believes is healthy for you bleeding from your gums are! Be careful when you use knives, scissors, razors, or you have or! Last a further 36 hours to take advantage of the problem, however, if have!