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. 2020 Jul 11;17(14):4993. doi: 10.3390/ijerph17144993

Table 2.

Adjustment of VKA dose according to INR modified by [58].

DAYS OF THERAPY INR ACTION
DAY 1 1–1.3 Give 0.1–0.2 mg/kg orally (maximum 5 mg)
DAYS 2–4 1.1–1.3
1.4–1.9
2.0–3.0
3.1–3.5
>3.5		 Repeat initial dose
50% of initial dose
50% of initial dose
25% of initial dose
Stop therapy, check INR;
when INR <3.5 restart at 50 % of initial dose
OTHER DAYS 1.1–1.4
1.5–1.9
2.0–3.0
3.1–3.5
>3.5		 Increase dose (+20%)
Increase dose (+10%)
Continue same dosage
Decrease dose (−10%)
Stop therapy, check INR;
when INR <3.5 restart at 20 % of dose