Hematology

Warfarin Supratherapeutic INR & Reversal Nomogram (CHEST Guidelines)

Provides guideline-directed 4F-PCC, Vitamin K, and dose-hold recommendations for elevated INR and bleeding.

Enlarge

Parameters

Warfarin Supratherapeutic INR & Reversal Nomogram (CHEST Guidelines) Result

Formula

CHEST Guidelines:
• INR 4.5–10 (No Bleed): Hold 1–2 doses, no routine Vit K
• INR > 10 (No Bleed): Hold Warfarin + 2.5–5 mg Oral Vit K
• Major Bleed: 4F-PCC (25–50 U/kg, max 5000 U) + 10 mg IV Vit K

Clinical Pearls

Standardizes critical emergency department and inpatient reversal protocols, drastically decreasing hematoma expansion and intracranial mortality.

Limitations

4F-PCC contains heparin; contraindicated in patients with known Heparin-Induced Thrombocytopenia (HIT).