🩸 Warfarin & INR Management
Warfarin reference: target INR by indication, high-INR and bleeding management per ACCP/CHEST, interactions and missed-dose advice. Browser-side.
Warfarin & INR Management
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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
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.