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
- High initial INR – First 7 days are rapid suppression of Factor VII