SudaMediCa, The Sudanese Medical Community

known case of chronic atrial fibrillation on the warfarin 5 mg came for follow up you find INR 7 but no signs of bleeding you advice is:
a) Decrease dose to 2.5 mg
b) Stop the dose & repeat INR next day
c) Stop warfarin
d) Continue same and repeat INR

a

b

Correct answer b
According to recommendations from the British Society of haematologists- see (BNF); based on INR and the presence and absence of major bleeding:
*** Major bleeding ---------- stop warfarin,
Give 5mg iv vitamin K ,
50 units/Kg prothrombin complex concentrate or fresh frozen plasma(FFP) 15ml/kg ,
*** INR > 8 ------------------- No bleeding or minor bleeding: stop warfarin and restart when INR < 5 ,
If other risk factors for bleeding : 0.5 mg iv vitamin K or 5mg PO vitaminK ,
repeat if INR still too high after 24 hours
*** INR 6 - 8 ------------------ No bleeding or minor bleeding: stop warfarin and restart when INR < 5
***INR < 6 OR > 0.5 above target INR ------- Reduce dose OR stop warfarinand restart when INR < 5