🩸 Warfarin & INR Management
UseBedside reminder of INR targets and how to manage a supratherapeutic INR or bleeding. Specific vitamin K/PCC …
SourceHolbrook A, et al. Antithrombotic therapy and prevention of thrombosis, ACCP/CHEST. 2012
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
Serious bleeding: stop, IV vitamin K + 4-factor PCC (or FFP), haematology consult.
When to use
Bedside reminder of INR targets and how to manage a supratherapeutic INR or bleeding. Specific vitamin K/PCC doses follow institutional protocol.
How it works
Target INR 2.0–3.0 for most indications; 2.5–3.5 for mitral mechanical valves/high-risk. INR > 10 without bleeding: hold + oral vitamin K 2.5–5 mg.
Key points
- Serious bleeding: stop, IV vitamin K + 4-factor PCC (or FFP), haematology consult.
- Many antibiotics, amiodarone and azoles raise INR; rifampin and enzyme inducers lower it.
- Missed dose: take that day's dose when remembered; do not double up.
- Monitor every 4 weeks once stable; recheck 1–2 weeks after dose changes.
References
- [Guideline / primary source]Holbrook A, et al. Antithrombotic therapy and prevention of thrombosis, ACCP/CHEST. 2012
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| View | High INR / bleeding management |
|---|
→Key pointHigh INR / bleeding management (ACCP/CHEST)
- Upper-therapeutic to 4.5：Reduce or hold one dose, resume in range; usually no vitamin K
- INR 4.5–10, no bleeding：Hold warfarin; do not routinely give vitamin K (oral 1–2.5 mg if high bleeding risk / urgent surgery)
- INR > 10, no bleeding：Hold + vitamin K 2.5–5 mg orally; monitor INR
| View | Target INR |
|---|
→Key pointTarget INR
- Most indications：2.0–3.0 (AF, VTE, first 3 months after a bioprosthesis, low-risk aortic mechanical valve)
- Mitral mechanical valve / high-risk：2.5–3.5
- Monitoring：Every 4 weeks once stable; recheck 1–2 weeks after a dose change
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Warfarin & INR Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Warfarin & INR Management upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Warfarin & INR Management calculated in practice? Can you show a worked example?
- Inputs: View High INR / bleeding management → Result: Key point High INR / bleeding management (ACCP/CHEST)（Upper-therapeutic to 4.5: Reduce or hold one dose, resume in range; usually no vitamin K, INR 4.5–10, no bleeding: Hold warfarin; do not routinely give vitamin K (oral 1–2.5 mg if high bleeding risk / urgent surgery), INR > 10, no bleeding: Hold + vitamin K 2.5–5 mg orally; monitor INR） Inputs: View Target INR → Result: Key point Target INR（Most indications: 2.0–3.0 (AF, VTE, first 3 months after a bioprosthesis, low-risk aortic mechanical valve), Mitral mechanical valve / high-risk: 2.5–3.5, Monitoring: Every 4 weeks once stable; recheck 1–2 weeks after a dose change）