Day | INR | Dose when starting with 5 mg tablet | Dose when starting with 3 mg tablet* |
---|---|---|---|
1 | - | 5 mg | 3 mg |
2 | - | 5 mg | 3 mg |
3 | <2.0 | 5 mg | 3 mg |
2.0-2.4 | 5 mg | 3 mg | |
2.5-2.9 | 2.5 mg | 1.5 mg | |
3.0-3.4 | 2.5 mg | Omit the next dose or 1.5 mg | |
3.5-4.0 | 1.5 mg (Note! Different tablet strength) | Omit the next dose | |
>4.0 | Omit the next dose | Omit the next dose | |
4-6 | <1.4 | 10 mg | 6 mg |
1.4-1.9 | 7.5 mg | 6 mg | |
2.0-2.4 | 5 mg | 3 mg | |
2.5-2.9 | 5 mg | 3 mg | |
3.0-3.9 | 2.5 mg | 1.5 mg | |
4.0-4.5 | Omit the next dose, then 1.5 mg (Note! Change to 3 mg tablet) | Omit the next dose, then 1.5 mg | |
>4.5 | Omit the next 2 doses, then 1.5 mg (Note! Change to 3 mg tablet) | Omit the next 2 doses, then 1.5 mg | |
Weekly dose based on INR value | |||
7- | 1.1-1.4 | Increase the weekly dose by 20% | |
1.5-1.9 | Increase the weekly dose by 10% | ||
2.0-3.0 | Same weekly dose | ||
3.1-4.5 | Decrease the weekly dose by 10% | ||
>4.5 | Stop until INR < 4.5, restart with a 20% smaller weekly dose |
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When adjusting anticoagulant therapy, notice that thrombotic complications occur more often when INR falls under the lower limit of therapeutic range (2.0 or 2.5) than bleeding complications occur when INR exceeds the therapeutic range, when the degree of being under or over the therapeutic range (in absolute numbers) is equal in size. The curve describing frequency of complications is exponential when INR is under 2.0 or over 4.5.
INR determinations Vitamin K for Improved Anticoagulation Control in Patients Receiving Warfarin, Computer-Assisted Management of Anticoagulant Therapy, Self-Monitoring and Self-Management of Oral Anticoagulation
Interactions
Potentiating the effect
Duration of the treatment Duration of Anticoagulant Therapy in Venous Thromboembolism, Anticoagulation for the Long Term Treatment of Venous Thromboembolism in Patients with Cancer
Pregnancy and breastfeeding
Temporary reduction of warfarin dose; bridging therapy
Amending warfarin therapy for planned surgery and invasive procedures
Thrombosis despite warfarin therapy
Complications
Treatment of bleeding complications Prothrombin Complex Concentrate for Reversal of Vitamin K Antagonist Treatment, Tranexamic Acid in People on Anticoagulants Undergoing Minor Oral Surgery or Dental Extractions
High INR without bleeding
References
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