INR too high guidelines

Question 1

What to do if someone on warfarin has major bleeding?

Answer 1

IV vitamin K (phytomenadione) and prothrombin complex concentrate (PCC)

Question 2

What to do if a patient’s INR is above 8 with minor bleeding?

Answer 2

Stop warfarin and give IV vitamin K, repeat after 24 hours if INR too high
Restart warfarin when INR less than 5

Question 3

What to do if a patient’s INR is above 8 with no bleeding?

Answer 3

Stop warfarin and give oral vitamin K, repeat after 24 hours if INR too high
Restart warfarin when INR less than 5

Question 4

What to do if a patient’s INR is between 5 and 8 with minor bleeding?

Answer 4

Stop warfarin and give IV vitamin K
Restart warfarin when INR less than 5

Question 5

What to do if a patient’s INR is between 5 and 8 with no bleeding?

Answer 5

Withhold 1 or 2 doses of warfarin and reduce subsequent maintenance dose