INR |
Action |
<1.5 | increase 10 - 20% |
1.5 - 1.9 | increase 5 - 10% |
2.0 - 3.0 | continue some dose |
3.1 - 3.9 | decrease 5 - 10% |
4.0 - 4.9 | hold 1 day + decrease 10% |
5.0 - 8.9 | hold 2 day + Vit K 1-2.5 mg PO + decrease 20% |
ตั้งแต่ 9 ขึ้นไป | hold 2 day + Vit K 1-2.5 mg PO |
Major bleeding (any INR) | hold drug + Vit K 10 mg IV + FFP + repeat INR g 12 h |