prolonged INR (whilst on warfarin)
Last reviewed 01/2018
- the 1998 BJH guidelines stated (1):
- if 3.0 < INR < 6.0 (target
INR 2.5) then:
- reduce warfarin dose/stop warfarin
- restart warfarin when INR < 5.0
- if 4.0 < INR < 6.0 (target INR 3.5)
- reduce warfarin/stop warfarin
- restart warfarin when INR < 5.0
- if
6.0 < INR < 8.0 and no bleeding or minor bleeding then:
- stop warfarin
- restart when INR < 5.0
- if INR > 8.0 and no bleeding or minor bleeding
then:
- stop warfarin
- restart warfarin when INR < 5.0
- if other risk factors for bleeding then give 0.5-2.5mg of oral vitamin K
- if
major bleeding then:
- stop warfarin
- give prothrombin concentrate 50 units per kg or FFP 15 ml/kg
- give 5 mg of vitamin K (oral or iv)
- if 3.0 < INR < 6.0 (target
INR 2.5) then:
Reference:
- Guidelines on oral anticoagulation: third edition . British Journal of Haematology 1998;101 (2): 374-387.