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Prolonged INR (whilst on warfarin)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • 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)

Reference:

  1. Guidelines on oral anticoagulation: third edition . British Journal of Haematology 1998;101 (2): 374-387.

 

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