INR (TARGET RANGE 2-3)
 

WARFARIN DOSE

Less than  1.3

10 mg

7.5 mg (increased warfarin sensitivity)‡

1.31-1.7

7.5 mg

5 mg (increased warfarin sensitivity)‡

1.71-2.5

5 mg

2.5 mg (increased warfarin sensitivity)‡

2.51-3.0

2.5 mg

1 mg (increased warfarin sensitivity)‡

Greater than  3.0

0, 1, or 2.5 mg depending on prior response

> 4.5

No Warfarin.  Pharmacist to call MD

‡ increased warfarin sensitivity: age greater than 70 years or weight less than 50 kg
 or malnourished or drug interactions or liver dysfunction

-  if INR still less than 1.3 on day 4, increase subsequent recommended dosages by 2.5mg

-  if INR still less than 2.0 on day 5, increase subsequent recommended dosages by 2.5mg