Warfarin: management of high INR
The following is based on the BNF guidelines, which in turn take into account the British Committee for Standards in Haematology (BCSH) guidelines. A 2005 update of the BCSH guidelines emphasised the preference of prothrombin complex concentrate over FFP in major bleeding.
*as FFP can take time to defrost prothrombin complex concentrate should be considered in cases of intracranial haemorrhage
| Situation | Management |
|---|---|
| Major bleeding | Stop warfarin Give intravenous vitamin K 5mg Prothrombin complex concentrate - if not available then FFP* |
| INR > 8.0 Minor bleeding | Stop warfarin Give intravenous vitamin K 1-3mg Repeat dose of vitamin K if INR still too high after 24 hours Restart warfarin when INR < 5.0 |
| INR > 8.0 No bleeding | Stop warfarin Give vitamin K 1-5mg by mouth, using the intravenous preparation orally Repeat dose of vitamin K if INR still too high after 24 hours Restart when INR < 5.0 |
| INR 5.0-8.0 Minor bleeding | Stop warfarin Give intravenous vitamin K 1-3mg Restart when INR < 5.0 |
| INR 5.0-8.0 No bleeding | Withhold 1 or 2 doses of warfarin Reduce subsequent maintenance dose |
*as FFP can take time to defrost prothrombin complex concentrate should be considered in cases of intracranial haemorrhage