What should be done if the protime is excessively long or if I having bleeding while on warfarin?
If the INR is between 5 and 9 and there is no bleeding, the American College of Chest Physicians (ACCP) recommends holding warfarin and monitoring. If the situation is urgent (i.e. there is high risk of bleeding or surgery is needed) one can consider giving Vitamin K 1 mg orally (subcutaneous administration is not advised due to erratic absorption). Four clinical trials demonstrated that while vitamin K administration was superior to simple withdrawal of warfarin in reducing the INR, it was not superior in reducing the incidence of bleeding. Therefore, if you can wait it out, the moral of the story is that simply stopping warfarin and monitoring the INR is an appropriate management strategy, even with an INR as high as 9. If the INR is higher than 9 and there is insignificant bleeding, higher doses of oral vitamin K (2.5 to 5 mg) and INRmonitoring are suggested. What if there is major bleeding? The ACCP recommends stopping warfarin, giving IV vitamin K (10 mg, slowly), giving plasma an
