| INR | Symptoms | Recommendation |
| Above therapeutic range but below 6 | No bleeding and Rapid Reversal Not Indicated for Reasons of Surgical Intervention | Omit next few doses of warfarin and commence at a lower dose when INR is in therapeutic range |
| 6-10 | No Bleeding or When Rapid Reversal is Required for Elective Surgery | Administer subcutaneously 1.0-2.0 mg vitamin K; expect reduction in INR in 8 hr, many patients will be in therapeutic range in 24 hr, an additional dose of 0.5 mg can be given. Resume warfarin at lower dose when INR returns to the desired range. |
| >10 | No Bleeding | Administer subcutaneously 3.0 mg vitamin K; expect reduction in INR in 6 hr; check INR in 6 hr and repeat vitamin K if necessary |
| >20 | Serious Bleeding or Major Warfarin Overdose | Administer subcutaneously 10.0 mg vitamin K and supplement with fresh plasma transfusion or prothrombin complex concentrate depending on the urgency of the situation. Check INR every 6 hr; vitamin K may have to be repeated every 12 hr. |
| Life-threatening Bleeding/ Serious Warfarin Overdose | Administer subcutaneously prothrombin complex concentrate supplemented with 10 mg vitamin K to be repeated as necessary depending on the INR. It is not usually necessary to give vitamin K for the immediate reversal if prothrombin complex concentrates containing factor VII are used |
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