US guidelines for warfarin reversal22
| INR | Clinical situation | Action |
|---|---|---|
| FFP, fresh frozen plasma; INR, international normalised ratio; IV, intravenous; PCC, prothrombin complex concentrate. | ||
| Above therapeutic but <5 | No bleeding | Lower dose or omit warfarin |
| >5 but <9 | No bleeding | Omit warfarin |
| Monitor more frequently | ||
| High risk of bleeding | Vitamin K (1–2.5 mg orally; 2–4 mg orally if more urgent reduction needed) | |
| >9 | No bleeding | Omit warfarin |
| Vitamin K (3–5 mg orally) | ||
| >20 | Serious bleeding | Vitamin K (10 mg IV) |
| FFP or PCC | ||
| Any INR | Life threatening bleeding | Vitamin K (10 mg IV) |
| PCC | ||