Adjustment of VKA dose according to INR during initiation and maintenance phases of therapy
| INR . | Action . |
|---|---|
| Initiation | |
| Day 1 | |
| Baseline 1.0-1.3 | Give 0.1-0.2 mg/kg orally (maximum 5 mg) |
| Days 2-4 | |
| 1.1-1.3 | Repeat initial loading dose |
| 1.4-1.9 | 50% of initial loading dose |
| 2.0-3.0 | 50% of initial loading dose |
| 3.1-3.5 | 25% of initial loading dose |
| >3.5 | Hold until INR < 3.5 then restart at 50% of initial loading dose |
| Maintenance | |
| 1.1-1.4 | Increase dose by 20% |
| 1.5-1.9 | Increase dose by 10% |
| 2.0-3.0 | No change |
| 3.1-3.5 | Decrease dose by 10% |
| >3.5 | Hold until INR < 3.5 then restart at 20% of dose |
| INR . | Action . |
|---|---|
| Initiation | |
| Day 1 | |
| Baseline 1.0-1.3 | Give 0.1-0.2 mg/kg orally (maximum 5 mg) |
| Days 2-4 | |
| 1.1-1.3 | Repeat initial loading dose |
| 1.4-1.9 | 50% of initial loading dose |
| 2.0-3.0 | 50% of initial loading dose |
| 3.1-3.5 | 25% of initial loading dose |
| >3.5 | Hold until INR < 3.5 then restart at 50% of initial loading dose |
| Maintenance | |
| 1.1-1.4 | Increase dose by 20% |
| 1.5-1.9 | Increase dose by 10% |
| 2.0-3.0 | No change |
| 3.1-3.5 | Decrease dose by 10% |
| >3.5 | Hold until INR < 3.5 then restart at 20% of dose |