Guidelines for the Management of Supratherapeutic INR - American College of Chest Physicians INR above therapeutic range but < 5.0 • Lower dose or omit dose • Monitor more frequently and resume at lower dose when INR falls within therapeutic range (if INR only slightly above range, may not be necessary to decrease dose) INR > 5.0 but INR < 9.0 • Hold next 1—2 doses • Monitor more frequently and resume therapy at lower dose when INR falls within therapeutic range • Patients at high risk for bleeding: Hold warfarin and consider giving vitamin K1 1-2.5 mg orally; check INR in 24-48 h to ensure response to therapy INR > 9.0 • Hold warfarin • Vitamin K1 2.5-5 mg orally • Monitor frequently and resume therapy at lower dose when INR within therapeutic range Life Threatening Bleed • Hold warfarin and give 10 mg vitamin K by slow intravenous infusion supplemented by FFP, PCC, or recombinant factor VIIa (PCC preferred) #Supratherapeutic #INR #Elevated #Anticoagulation #Reversal #Guidelines #Warfarin #Coumadin
