Suggested treatment strategies for various international normalized ratio (INR) values in patients receiving warfarin administered to achieve a target INR of 2.0 to 3.0. For patients receiving warfarin with a higher target INR, the ranges presented should be adjusted upwards. In all cases, the cause of the excessive prolongation of the INR should be sought, and corrected.
| INR value . | Clinical Data . | Treatment strategy . |
|---|---|---|
| Any elevation | Life threatening bleeding | 1. Withhold warfarin. |
| 2. Replace coagulation factors using plasma or complex concentrates. | ||
| 3. Administer intravenous vitamin K (5 to 10 mg, with the dose depending on the INR). | ||
| 4. Correct mechanical causes of hemorrhage. | ||
| 5. Provide medical support, including transfusion, as required. | ||
| Any elevation | Major (non-life threatening bleeding) | 1. Withhold warfarin. |
| 2. Consider administration of plasma or complex concentrates. | ||
| 3. Administer intravenous vitamin K (1 to 10 mg, with the dose depending on the INR). | ||
| 4. Correct mechanical causes of hemorrhage. | ||
| 5. Provide medical support, including transfusion, as required. | ||
| 4.5 to 6.0 | No bleeding | 1. Withhold warfarin and recheck INR in 24 to 48 hours OR |
| 1. Withhold warfarin, administer 1 mg oral vitamin K and recheck INR in 24 to 48 hours OR | ||
| 1. Reduce warfarin dose, recheck INR in 24 to 48 hours | ||
| 6.1 to 10.0 | No bleeding | 1. Withhold warfarin and recheck INR in 24 hours OR |
| 1. Withhold warfarin, administer 1 mg oral vitamin K and recheck INR in 24 hours OR | ||
| 1. Withhold warfarin, administer 1 to 2.5 mg of oral vitamin K, consider using plasma or complex concentrates ONLY IN PATIENTS AT HIGH RISK OF HEMORRHAGE and recheck INR in 24 hours | ||
| 10.1 and above | No bleeding | 1. Withhold warfarin, administer 1 to 5 mg of oral vitamin K and recheck INR in 24 hours OR |
| 1. Withhold warfarin, administer 0.5 to 1.0 mg of intravenous vitamin K and recheck INR in 24 hours OR | ||
| 2. Withhold warfarin, administer 1 to 5 mg of oral vitamin K, consider using plasma or complex concentrates ONLY IN PATIENTS AT HIGH RISK OF HEMORRHAGE and recheck INR in 24 hours OR | ||
| 1. Withhold warfarin, administer 0.5 to 1.0 mg of intravenous vitamin K, consider plasma or complex concentrates ONLY IN PATIENTS WITH HIGH RISK OF HEMORRHAGE and recheck INR in 24 hours. |
| INR value . | Clinical Data . | Treatment strategy . |
|---|---|---|
| Any elevation | Life threatening bleeding | 1. Withhold warfarin. |
| 2. Replace coagulation factors using plasma or complex concentrates. | ||
| 3. Administer intravenous vitamin K (5 to 10 mg, with the dose depending on the INR). | ||
| 4. Correct mechanical causes of hemorrhage. | ||
| 5. Provide medical support, including transfusion, as required. | ||
| Any elevation | Major (non-life threatening bleeding) | 1. Withhold warfarin. |
| 2. Consider administration of plasma or complex concentrates. | ||
| 3. Administer intravenous vitamin K (1 to 10 mg, with the dose depending on the INR). | ||
| 4. Correct mechanical causes of hemorrhage. | ||
| 5. Provide medical support, including transfusion, as required. | ||
| 4.5 to 6.0 | No bleeding | 1. Withhold warfarin and recheck INR in 24 to 48 hours OR |
| 1. Withhold warfarin, administer 1 mg oral vitamin K and recheck INR in 24 to 48 hours OR | ||
| 1. Reduce warfarin dose, recheck INR in 24 to 48 hours | ||
| 6.1 to 10.0 | No bleeding | 1. Withhold warfarin and recheck INR in 24 hours OR |
| 1. Withhold warfarin, administer 1 mg oral vitamin K and recheck INR in 24 hours OR | ||
| 1. Withhold warfarin, administer 1 to 2.5 mg of oral vitamin K, consider using plasma or complex concentrates ONLY IN PATIENTS AT HIGH RISK OF HEMORRHAGE and recheck INR in 24 hours | ||
| 10.1 and above | No bleeding | 1. Withhold warfarin, administer 1 to 5 mg of oral vitamin K and recheck INR in 24 hours OR |
| 1. Withhold warfarin, administer 0.5 to 1.0 mg of intravenous vitamin K and recheck INR in 24 hours OR | ||
| 2. Withhold warfarin, administer 1 to 5 mg of oral vitamin K, consider using plasma or complex concentrates ONLY IN PATIENTS AT HIGH RISK OF HEMORRHAGE and recheck INR in 24 hours OR | ||
| 1. Withhold warfarin, administer 0.5 to 1.0 mg of intravenous vitamin K, consider plasma or complex concentrates ONLY IN PATIENTS WITH HIGH RISK OF HEMORRHAGE and recheck INR in 24 hours. |