Reversal of INR - Guidelines

The American College of Chest Physicians (ACCP) updated their recommendations on the use of vitamin K in June of 2008.

• Oral vitamin K is preferred to subcutaneous (SC) for patients with elevated INRs in the absence of major bleeding. 

• INR ≥5.0 and <9.0 – may give oral vitamin K 1 to 2.5 mg if the patient is at an increased risk for bleeding; up to 5 mg oral vitamin K may be given if more rapid reversal is required. Additional doses may be required.

• INR ≥9.0 – give vitamin K 2.5 to 5 mg orally; additional doses may be required.

• If the patient is experiencing serious or life-threatening bleeding, intravenous vitamin K 10 mg along with blood products should be administered.