Dosing Adjustment Nomogram for Maintenance Therapy
GOAL INR 2.0 - 3.0 |
GOAL INR 2.5 - 3.5 |
|
< 2.0 |
• reload x 0-1 • increase by 5-15% |
< 2.5 |
2.0 - 3.0 |
• no change |
2.5 - 3.5 |
3.1 - 3.5 |
• decrease by 0-15% |
3.6 - 4.0 |
3.6 - 4.0 |
• hold 0-1 dose • decrease by 5-15% |
4.1 - 4.5 |
> 4.0 |
• hold until therapeutic • +/- minidose vitamin K • decrease by 10-20% |
> 4.5 |
Adapted from: Crowther MA, Harrison L, Hirsch L. Ann Intern Med 1997; 127:332-3