Table 1 The FH-algorithm
From: Effects of computer-assisted oral anticoagulant therapy
Adjusting the Oral Anticoagulation Treatment | |||
|---|---|---|---|
2.0–3.0 | Therapeutic INC interval | 2.5–3.5 | |
INR | Acute treatment | Maintenance dosage | INR |
>10 | Give Vitk with or without FFP. Pause VKA until INR is within therapeutic interval (2- > 7 days) | Reduce to 50% or more | >10 |
6.0–10 | Pause VKA for 2–3 days. Vitk may be administered | Reduce 30–40% | 7.0–10 |
5.0–5.9 | Pause VKA for 1–2 days | Reduce 20–30% | 5.5–6.9 |
3.5–4.9 | Pause VKA for 0–1 day | Reduce 10–20% | 4.0–5.4 |
3.1–3.4 | None | Reduce 0–10% | 3.6–3.9 |
2.0–3.0 | None | No change | 2.5–3.5 |
1.7–1.9 | None | Increase 0–10% | 2.1–2.4 |
1.5–1.6 | Double dosage of VKA 1 day | Increase 20–30% | 1.7–2.0 |
<1.5 | Double dosage of VKA 1 day. Heparin may be administered | Increase 40–50% | <1.7 |