Table 1.

Summary of 2008 and 2012 vitamin K administration recommendations from the American College of Chest Physicians^4,7

INR range	Intervention	Level of evidence
2008 recommendations
INR <5 and no significant bleed	Lower or omit dose	1C
INR 5 to 8.9 and no significant bleed	Omit 1 to 2 doses OR omit dose and give 1 to 2.5 mg vitamin K PO if at increased risk of bleeding OR vitamin K ≤5 mg PO may be given if rapid reversal required due to surgery	1C
INR >9 and no significant bleed	Omit dose and give 2.5 to 5 mg PO vitamin K	1B
Serious bleed	Omit dose and give 10 mg vitamin K by slow IV infusion; may supplement with FFP, PCC, or rVIIa. Vitamin K may be repeated in 12 hours if satisfactory results are not yet obtained.	1C
Life-threatening bleed	FFP, PCC, or rVIIa + vitamin K 10 mg by slow IV infusion	1C
INR <5 and no significant bleed	Lower or omit dose	1C
2012 recommendations
INR 4.5-10 and no evidence of bleed	Suggest against the routine use of vitamin K	2B
INR > 10 and no evidence of bleed	Suggest oral vitamin K be administered	2C
VKA-associated major bleeding	Rapid reversal with 4-factor PCC rather than plasma	2C
	Suggest additional use of vitamin K 5 to 10 mg administered by slow IV injection rather than reversal with coagulation factors alone	2C

Note: FFP = fresh frozen plasma; INR = international normalized ratio; IV = intravenous; PCC = prothrombin complex concentrate; PO = by mouth; rVIIa = recombinant factor VIIa; VKA = vitamin K antagonist.