Dose-adjustment nomogram during initiation
| . | INR . | Warfarin dose adjustment . |
|---|---|---|
| Day 3 | < 1.3 | ↑ 10% |
| 1.3-1.5 | No change | |
| 1.6-1.8 | ↓ 10% | |
| 1.9-2.1 | ↓ 20% | |
| 2.2-2.5 | ↓ 50% | |
| > 2.5 | Hold dose for 1 day, then ↓ 50% | |
| Day 5/6 | < 1.3 | ↑ 50% |
| 1.4-1.7 | ↑ 20% | |
| 1.8-2.5 | No change | |
| 2.6-3.0 | ↓ 20% | |
| 3.1-3.9 | ↓ 50% | |
| ≥ 4.0 | Hold dose for 1 day, then ↓ 50% | |
| Day 7/8/9 | < 1.5 | ↑ 20% |
| 1.5-1.9 | ↑ 10% | |
| 2.0-2.8 | No change | |
| 2.9-3.5 | ↓ 10% | |
| 3.6-4.0 | Hold dose for 1 day, then ↓ 15% | |
| ≥ 4.0 | Hold dose, test INR daily until in range (2.0-3.0), then ↓ 25% |
| . | INR . | Warfarin dose adjustment . |
|---|---|---|
| Day 3 | < 1.3 | ↑ 10% |
| 1.3-1.5 | No change | |
| 1.6-1.8 | ↓ 10% | |
| 1.9-2.1 | ↓ 20% | |
| 2.2-2.5 | ↓ 50% | |
| > 2.5 | Hold dose for 1 day, then ↓ 50% | |
| Day 5/6 | < 1.3 | ↑ 50% |
| 1.4-1.7 | ↑ 20% | |
| 1.8-2.5 | No change | |
| 2.6-3.0 | ↓ 20% | |
| 3.1-3.9 | ↓ 50% | |
| ≥ 4.0 | Hold dose for 1 day, then ↓ 50% | |
| Day 7/8/9 | < 1.5 | ↑ 20% |
| 1.5-1.9 | ↑ 10% | |
| 2.0-2.8 | No change | |
| 2.9-3.5 | ↓ 10% | |
| 3.6-4.0 | Hold dose for 1 day, then ↓ 15% | |
| ≥ 4.0 | Hold dose, test INR daily until in range (2.0-3.0), then ↓ 25% |
↑indicates increase; and ↓, decrease.