VITAMIN K1 (PHYTONADIONE) USE FOR MANAGING PATIENTS WITH HIGH INR VALUES

CLINICAL SITUATION GUIDELINES INR greater than therapeutic range but Lower the dose or omit the next dose; less than 5.0, no clinically significant bleeding, resume warfarin therapy at a lower rapid reversal not indicated for reasons of dose when the INR approaches surgical intervention desired range. If the INR is only minimally above theraputic range, dose reduction may not be necessary. INR greater than 5.0 but less than 9.0, Patients with no additional risk no clinically significant bleeding factors for bleeding, omit the next dose or two of warfarin, monitor INR more frequently, and resume warfarin therapy at a lower dose when the INR is in theraputic range. Patients at increased risk of bleeding, omit the next dose of warfarin, and give vitamin KI(1.0 to 2.5 mg orally). Patients requiring more rapid reversal before urgent surgery or dental extraction, vitamin KI (2 to 4 mg orally); if the INR remains high at 24h, an additional dose of 1 to 2 mg. INR greater than 9.0, no clinically Vitamin K1 (3 to 5 mg orally),;closely significant bleeding monitor the INR; if the INR is not substantially reduced by 24 to 48 h, the vitamin KI dose can be repeated. Serious bleeding, or major warfarin overdose (eg. INR greater than 20.0) requiring very rapid reversal of anticoagulant effect. Vitamin KI (10 mg by slow IV infusion), with fresh plasma trans- fusion or prothrombin complex concentrate , depending upon urgency; vitamin KI injections may be needed q12h. Life-threatening bleeding or serious Prothrombin complex concentrate, warfarin overdose with vitamin KI (10mg by slow IV infusion), repeat if necessary, depending upon the INR. Continuing warfarin therapy indicated Heparin, until the effects of vitamin after high doses of vitamin KI KI have been reversed, and patient is responsive to warfarin.