Table of Contents
How do you manage elevated INR?
Vitamin K is a safe and effective antidote to warfarin. Both oral and intravenous (IV) routes are effective in reducing a raised INR due to warfarin with a similar correction of INR by 24 hrs. IV has a more rapid response, within 6-8 hours.
How are patients with high INR managed in their anticoagulant therapy?
Asymptomatic patients with an INR that is only slightly above the therapeutic maximum can often be managed simply by omitting their usual warfarin dose and increasing their frequency of INR monitoring. The INR will reduce over several days. Warfarin should be restarted, if necessary, when the INR falls below 5.0.
How do you manage warfarin toxicity?
Treatment / Management
- 4-factor Prothrombin Complex Concentrate*, if available or 3-factor PCC and Fresh frozen plasma. If 3 or 4 factor PCC not available, administer FFP alone.
- Intravenous Vitamin K10mg.
- Tranexamic acid administration should be considered.
How do you treat low INR levels?
If the patient is asymptomatic and the low level is picked up on a routine lab draw, then the treatment can range from simply monitoring the level if slightly low, increasing the patient’s oral intake of Vitamin K in diet or increasing the dose of the patient’s anticoagulant.
When do you treat elevated INR?
Management of Elevated INRs
| INR | Symptoms | Recommendations |
|---|---|---|
| INR 6-9 | Consider ER referral if high risk for bleed | Omit a dose Consider 2.5mg po Vitamin K Check INR daily |
| INR > 9 | Consider ER referral if high risk for bleed | Omit a dose Consider 5mg po Vitamin K Check INR daily |
| Any INR | Serious or life-threatening bleed | ED referral |
When do you give vitamin K for elevated INR?
What dose and route of administration should be used? For most warfarin-treated patients who are not bleeding and whose INR is >4.0, oral vitamin K (in doses between 1 and 2.5 mg) will lower the INR to between 1.8 and 4.0 within 24 hours.
Do you give heparin with high INR?
Warfarin should be started in conjunction with heparin or low molecular weight heparin when the diagnosis of venous thromboembolism is confirmed, although local protocols may vary in their starting doses and titration schedule. As indicated, heparin should be continued concomitantly for five days and until INR is >2.
What medications increase INR?
Colestipol. Estrogens. Sucralfate. Dicloxacillin, Naficillin.
What drugs decrease INR?
Drugs that can decrease warfarin effect & lower INR in some pts include antacids, antihistamines, barbiturates, rifampin, sucralfate, trazodone, carbamazepine, cholestyramine, griseofulvin, haloperidol, oral contraceptives, penicillin, dicloxacillin, and nafcillin.
Can you give warfarin and heparin at the same time?
While warfarin is being initiated, patients who require rapid anticoagulation should also be given unfractionated heparin or low-molecular-weight heparin intravenously or subcutaneously in doses appropriate for the given indication. Heparin and warfarin therapies should overlap for approximately four to five days.
What happens when INR is too high?
The higher your PT or INR, the longer your blood takes to clot. An elevated PT or INR means your blood is taking longer to clot than your healthcare provider believes is healthy for you. When your PT or INR is too high, you have an increased risk of bleeding.
When do you treat high INR with vitamin K?
This evidence suggests that the use of low-dose oral vitamin K therapy should be confined to patients with INRs below 10. Among the studies that examined INR values below 10, the threshold for intervention with vitamin K ranged from 4.5 to 6.0.
When do you give FFP for elevated INR?
In general, FFP should be transfused when clotting studies become abnormal, including a prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT). Nonsurgical bleeding in children who receive more than 1 blood volume of PRBCs frequently require FFP due to factor V and VIII deficiency.
What is considered a critical INR level?
Normal and Critical Findings. For normal patients who are not on anticoagulation, the INR is usually 1.0 regardless of the ISI or the particular performing laboratory. For patients who are on anticoagulant therapy, the therapeutic INR ranges between 2.0 to 3.0. INR levels above 4.9 are considered critical values and increase the risk of bleeding.
How often should INR levels be measured?
Measuring the INR every 24 hours is usually sufficient unless clinical deterioration occurs. Asymptomatic patients with an INR that is only slightly above the therapeutic maximum can often be managed simply by omitting their usual warfarin dose and increasing their frequency of INR monitoring. The INR will reduce over several days.
What should I do if my INR is high?
Eat the same amount of vitamin K daily to keep your INR stable. Vitamin K changes how your blood clots and affects your INR. Vitamin K is found in green leafy vegetables, broccoli, grapes, and other foods. Ask your healthcare provider for more information about what to eat when you have an elevated INR. Limit alcohol. Alcohol increases your INR.
Are You monitoring your patients’ INRS properly?
Appropriate management of warfarin therapy requires monitoring of patients’ international normalised ratios (INRs). While pharmacists often monitor their patients’ INRs, it is usually doctors who manage patients who have become over-anticoagulated.