Table 3

Overview from published guidelines of interventions for patients anticoagulated with warfarin according to INR status, need for invasive procedures and bleeding risk or severity

PresentationIntervention
INR in therapeutic range, but non-urgent invasive procedure required4 32

  • ▸ Interrupt warfarin for ≥1 doses until INR falls to required value*

INR in therapeutic range, minor bleeding32

  • ▸ Interrupt warfarin*

  • ▸ Consider oral vitamin K†

INR moderately elevated (eg, INR <5) and low risk of bleeding1 32

  • ▸ Interrupt warfarin*

INR moderately elevated (eg, INR <5) and minor bleed or high risk of bleeding1 32

  • ▸ Interrupt warfarin*

  • ▸ Administer oral vitamin K†

INR very high (eg, INR 5–9), but no bleeding or no clinically significant bleeding1 32

  • ▸ Interrupt warfarin*

  • ▸ Administer oral vitamin K†

INR >9, but no bleeding or no clinically significant bleeding1 32

  • ▸ Interrupt warfarin*

  • ▸ Administer oral vitamin K†

Clinically significant bleeding and/or INR >2032

  • ▸ Interrupt warfarin*

  • ▸ Administer:

  •  – Intravenous vitamin K†

  •  – Blood or blood products†

Life-threatening bleeding (eg, intracranial haemorrhage) or extreme warfarin overdose1 4 32 61 62

  • ▸ Interrupt warfarin*

  • ▸ Administer:

  •  – Intravenous vitamin K†

  •  – Blood or blood products†

  •  – Prothrombin complex concentrate†

  • *For details on interrupting or stopping warfarin, see Ageno et al4 and Hirsh et al.32

  • †For details on dosage and administration of vitamin K, blood products, and so on, see Holbrook et al,1 Ageno et al,4 ,61 Hirsh et al32 and Morgenstern et al.62

  • INR, international normalised ratio.