High INR

Patients sometimes present to ED or are send to ED due to over anticoagulation with warfarin

1. Is there Major/Significant bleeding?


  • Resuscitate (ABCD)
  • Give 5mg Vitamin K IV
  • Octaplex Guide
  • Treat bleeding and admit to appropriate speciality

NO & INR ≥ 8 – Ask Question 2

NO & INR < 8

  • Stop or Reduce warfarin (15% reduction should reduce INR by 1)
  • Consider drug interactions – interaction list
  • Review in next Anticoagulation Clinic

2. Are there ANY high risk indication?

  • Frail/elderly
  • Recent surgery (within 1 month)
  • Previous GI bleed
  • Previous CVA
  • Renal Failure
  • Known severe liver impairment/alcohol abuse
  • INR >15


  • Withhold warfarin
  • Consider admission to MAU
  • Give 2mg Vitamin K IV
  • Rpt INR in 24hr


  • Withhold warfarin
  • Give 2mg Vitamin K Oral
  • May go home
  • Rpt INR in 24hr (can happen AAU)
  • Consider drug interactions – Interaction list

Adapted from

search: inr guidelines, warfarin guidelines

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