High INR & Anticoagulation (1*)

Question 1

What are the typical target INRs?

Answer 1

• 2-3 for VTE, AF, Post-MI, Valve replacement
• 3-4 for recurrent VTE whilst on anticoagulants

Question 2

Whilst on warfarin, what should be done if:
INR 5-8 with no bleed?

INR 5-8 with minor bleed?

INR 8+ with no bleed?

INR 8+ with minor bleed?

Any major bleed?

Answer 2

➊ Withhold 1/2 doses and restart at a lower dose

➋ Stop warfarin, give Slow IV Vit K, and restart warfarin once INR < 5

➌ Stop warfarin, give Oral Vit K, repeat if INR still high after 24 hrs, and restart warfarin once INR < 5

➍ Stop warfarin, give Slow IV Vit K, repeat if INR still high after 24 hrs, and restart warfarin once INR < 5

➎ Stop warfarin, give Slow IV Vit K and Prothrombin complex concentrate (if unavailable, give FFP)

N.B. Prothrombin complex concentrate has many of the clotting factors, therefore providing a much more complete and rapid reversal of warfarin overdose than FFP