This paper has the management of Drug Induced Supra therapeutic INR and a case presentation of 33-year-old Male patient who was on oral anticoagulant (Vitamin K antagonist-VKA) and antiplatelet therapy presented with supra-therapeutic international normalized ratio (INR) with history of Single episode of blood stained Sputum. The patient is known case of posterior circulation stroke with left ventricular clot, Cortical venous sinus thrombosis with left parietal hematoma and secondary seizure, ischemic heart disease (IHD) status post Percutaneous Transluminal Coronary Angioplasty (PTCA) to LAD with left ventricular ejection fraction (LVEF) - 30% and hyper-homocysteinemia. The patient presented with history of single episode of blood stain sputum and with no other complaints. His routine blood investigation revealed INR of 9.50 hence the patient was admitted and treated accordingly. Patients INR returned to normal after appropriate medical management. Patient was discharged with a titrated dose, advised on treatment, education and adherence counselling.