Can focal nodular dysplasia (FND) cause elevated International Normalized Ratio (INR)?

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Last updated: June 13, 2025View editorial policy

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From the Guidelines

Focal nodular dysplasia (FND) does not typically cause elevated International Normalized Ratio (INR). The liver's ability to synthesize clotting factors is not significantly impaired in FND, a benign liver lesion. According to the study on coagulation in cirrhosis 1, the liver plays a crucial role in producing clotting factors, and conditions that impair liver function can lead to coagulopathy. However, FND is not typically associated with significant liver dysfunction.

Key Points to Consider

  • FND is a benign liver lesion that does not typically impair liver function or interfere with the liver's ability to produce clotting factors 1.
  • The liver continues to synthesize adequate amounts of clotting factors II, VII, IX, and X, which are vitamin K-dependent factors measured by the INR.
  • If a patient with FND has an elevated INR, clinicians should investigate other causes such as medication use, vitamin K deficiency, liver disease elsewhere in the organ, or coagulopathies unrelated to the FND.
  • Regular liver function tests in patients with FND typically show normal results, including normal coagulation parameters. It is essential to note that while FND itself is unlikely to cause elevated INR, other underlying conditions or factors may contribute to coagulopathy in these patients. Therefore, a thorough evaluation is necessary to determine the cause of an elevated INR in patients with FND.

From the Research

Focal Nodular Dysplasia and Elevated INR

  • Focal nodular dysplasia (FND) is a benign hepatic tumor, and its relationship with elevated International Normalized Ratio (INR) is not directly addressed in the provided studies.
  • The studies focus on the characteristics, diagnosis, and management of focal nodular hyperplasia (FNH) and other liver lesions, as well as the causes of elevated INR in intensive care unit patients 2.
  • There is no direct evidence to suggest that FND causes elevated INR, as the provided studies do not discuss this specific relationship.
  • However, it is known that liver disease can affect coagulation and lead to elevated INR, as seen in the study on causes of elevated INR in the intensive care unit 2.
  • The studies on FNH and other liver lesions provide information on the diagnosis and management of these conditions, but do not address the specific question of whether FND can cause elevated INR 3, 4, 5, 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Atypical focal nodular hyperplasia of the liver.

Hepatobiliary & pancreatic diseases international : HBPD INT, 2011

Research

Focal nodular hyperplasia of the liver: radiologic-pathologic correlation.

Radiographics : a review publication of the Radiological Society of North America, Inc, 1996

Research

Focal Nodular Hyperplasia and Focal Nodular Hyperplasia-like Lesions.

Radiographics : a review publication of the Radiological Society of North America, Inc, 2022

Research

ACG Clinical Guideline: Focal Liver Lesions.

The American journal of gastroenterology, 2024

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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