Warfarin + high INR

Question 1

Major bleeding (3)

Answer 1

Stop warfarin
Give IV vitamin K 5mg
Prothrombin complex concentrate

Question 2

Stop warfarin
Give IV vitamin K 5mg
Prothrombin complex concentrate

Answer 2

Major bleeding

Question 3

INR >8.0 + minor bleeding (4)

Answer 3

Stop warfarin
Give IV vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hrs
Restart warfarin when INR <5.0

Question 4

Stop warfarin
Give IV vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hrs
Restart warfarin when INR <5.0

Answer 4

INR >8.0 + minor bleeding

Question 5

INR >8.0 + no bleeding (4)

Answer 5

Stop warfarin
Give vitamin K 1-5mg by mouth
Repeat dose of vitamin K if INR still too high after 24 hrs
Restart warfarin when INR <5.0

Question 6

Stop warfarin
Give vitamin K 1-5mg by mouth
Repeat dose of vitamin K if INR still too high after 24 hrs
Restart warfarin when INR <5.0

Answer 6

INR >8.0 + no bleeding

Question 7

INR 5.0-8.0 + minor bleeding (3)

Answer 7

Stop warfarin
Give IV vitamin K 1-3mg
Restart when INR <5.0

Question 8

Stop warfarin
Give IV vitamin K 1-3mg
Restart when INR <5.0

Answer 8

INR 5.0-8.0 + minor bleeding

Question 9

INR 5.0-8.0 + no bleeding (2)

Answer 9

Withhold 1 or 2 doses of warfarin

Reduce subsequent maintenance dose

Question 10

Withhold 1 or 2 doses of warfarin

Reduce subsequent maintenance dose

Answer 10

INR 5.0-8.0 + no bleeding