Management of Elevated INRs

INR	Symptoms	Recommendations
INR > therapeutic < 5	No significant bleeding	Omit a dose Resume at a lower dose RTC in 1 week
INR 5-6	No significant bleeding	Omit a dose Consider 500mcg po Vitamin K (available OTC) RTC in 1 week
INR 6-9	Consider ER referral if high risk for bleed	Omit a dose Consider 2.5mg po Vitamin K Check INR daily
INR > 9	Consider ER referral if high risk for bleed	Omit a dose Consider 5mg po Vitamin K Check INR daily
Any INR	Serious or life-threatening bleed	ED referral

Increase or decrease oral Vitamin K administration based on the clinical situation.
Parenteral Vitamin K should only be used for life-threatening bleeding and is therefore not appropriate for outpatient use.
Use the recommendations for the next lower INR range in the following situations:

High initial INR – First 7 days are rapid suppression of Factor VII
(the faster the INR goes up, the faster it comes down)
High thrombosis risk – First 30 days following venous thromboembolism
Active malignancy
Antiphospholipid Antibodies (APLA)
Femoral Bypass Graft

Anticoagulation Guidelines & Recommendations