CORRECTION OF OVER-ANTICOAGULATION
Referral Form (pdf)
When to Call Your Anticoagulation Clinic (pdf)
Guidelines For Correction of Warfarin Over-Anticoagulation
Adapted from Ansell J et al. Chest 2004; 126 (suppl 3): 204-233
===================================================
INR CLINICAL SETTING THERAPEUTIC OPTIONS < 5 No bleeding Hold warfarin until INR in therapeutic range +/- vitamin K 2.5mg po Rapid reversal required Hold warfarin and give vitamin K 1mg IV infusion or 2.5mg po 5.0-8.9 No bleeding Hold warfarin until INR in therapeutic range +/- vitamin K 2.5mg po Rapid reversal required Hold warfarin and give vitamin K 1-2mg IV infusion or 2.5-5mg po > 9 No bleeding Hold warfarin until INR in therapeutic range and give vitamin K 2.5-5mg po or 1-2mg IV and may repeat q24h as necessary Rapid reversal required Hold warfarin and give vitamin K 1-10mg IV and may repeat q6-24h as necessary Any INR Serious or life threatening bleeding Hold warfarin and give vitamin K 10mg IV infusion and supplement with FFP or PPC or recombinant VIIa and repeat as necessary guided by INR
Hold warfarin until INR in therapeutic range +/- vitamin K 2.5mg po
Hold warfarin and give vitamin K 1mg IV infusion or 2.5mg po
Hold warfarin and give vitamin K 1-2mg IV infusion or 2.5-5mg po
Hold warfarin until INR in therapeutic range and give vitamin K 2.5-5mg po or 1-2mg IV and may repeat q24h as necessary
Hold warfarin and give vitamin K 1-10mg IV and may repeat q6-24h as necessary
Hold warfarin and give vitamin K 10mg IV infusion and supplement with FFP or PPC or recombinant VIIa and repeat as necessary guided by INR