From the Guidelines

An INR above 1.25 is generally considered elevated in patients not on anticoagulants.

The interpretation of INR targets in patients not on anticoagulant therapy is based on arbitrary extrapolation from bleeding rates in anticoagulant trials and population-specific observational studies lacking controls 1.
In the context of liver disease, an INR range of 1.1 to < 1.25 is considered mildly elevated, while an INR of 1.25 to < 1.5 is considered moderately elevated 1.

However, it is essential to note that INR is a poor predictor of bleeding risk in patients with liver disease, disseminated intravascular coagulation, massive transfusion, and acute trauma 1.
Randomized clinical trials have found no reduction in bleeding when prophylactic plasma is given to correct INR values in periprocedural, critically ill, and liver disease patients 1.
A recent systematic review assessing the predictive accuracy of pre-procedural INR found weak or no association between INR and bleeding in 78 out of 79 studies assessed 1.

In clinical practice, an INR above 1.25 may be considered elevated, but its predictive value for bleeding risk is limited, and other factors such as liver function, platelet count, and overall clinical condition should be taken into account 1.

From the Research

The definition of an elevated International Normalized Ratio (INR) can vary depending on the context and population being studied.
Generally, an INR above 1.0 is considered elevated, but the degree of elevation can have different implications in different situations 2.

Studies have shown that patients not on anticoagulant therapy can still have elevated INR values, which may be associated with increased mortality risk 2.
An INR above 1.25 may be considered elevated in patients not on anticoagulants, as values above this threshold have been linked to increased bleeding risks and mortality in certain populations 3, 2.
However, the clinical significance of an INR elevation in patients not on anticoagulants is not fully understood and may depend on various factors, such as underlying medical conditions and comorbidities 4, 2.

INR elevations can be caused by various factors, including vitamin K deficiency, liver disease, and the use of certain medications, such as direct oral anticoagulants (DOACs) 5, 4.
In patients not on anticoagulant therapy, INR elevations may be more likely to be caused by underlying medical conditions, such as liver disease or vitamin K deficiency, rather than anticoagulant therapy 5.

Elevated INR values in patients not on anticoagulants may be associated with increased bleeding risks and mortality, particularly in patients with underlying medical conditions or comorbidities 3, 2.
Clinicians should be aware of the potential causes of INR elevations in patients not on anticoagulants and interpret INR results in the context of the patient's overall clinical picture 4, 2.