Table of Contents

  VITAMIN K FOR TREATMENT OF HYPOPROTHROMBINEMIA FROM
  ORAL ANTICOAGULANTS

 

INR

 

RECOMMENDATION

 

Less than 5 and no bleeding

 

No vitamin K. Lower or omit warfarin dose; resume at lower dose when INR in therapeutic range.

 

5 or greater but less than 9 and no bleeding

 

Hold warfarin x 1-2 doses; resume at lower dose when in INR therapeutic range. May give vitamin K 1-2.5 mg PO* or slow IV. Review INR within 24 hours. 

 If more rapid reversal required, give vitamin K 5mg PO or slow IV. May repeat vitamin K 1-2mg if necessary at 24 hours.

 

9 or greater and no bleeding

 

Hold warfarin. Give vitamin K 2.5-5 mg PO or slow IV. Review INR in 12 hours.

 

Serious bleed

 

Hold warfarin. Give vitamin K 10mg slow IV supplemented with fresh frozen plasma.  Review INR in 12 hours and repeat vitamin K if necessary.

  * subcutaneous route may result in delayed and unpredictable response; PO is the preferred route
     if INR < 9.0 and no active bleed or imminent surgery; contents of ampoule may be given orally;
     withdraw contents of ampoule with a fine gauge needle

     Reference: Chest 2008;133:175S.