What is the primary concern when a patient presents with an INR greater than 3.5?

When a patient presents with an INR greater than 3.5, the primary concern is high bleeding risk. The International Normalized Ratio (INR) is a measure used to assess how well and how quickly blood clots. An INR above the therapeutic range indicates that the blood is taking longer to clot, which increases the risk of spontaneous bleeding or bleeding from minor injuries. Clinically, it is crucial to monitor patients closely when their INR is elevated, as this could lead to serious complications, including gastrointestinal bleeding, intracranial hemorrhaging, or other significant bleeding episodes.

Other options such as a low risk of bleeding, increased eligibility for physical therapy, or normal clotting ability do not accurately reflect the implications of having an elevated INR. Increased bleeding risk necessitates careful management, which may include potential adjustments to anticoagulant therapy or more vigilant monitoring.