Simplified nomogram for warfarin maintenance dosing

Goal INR 2-3  

Goal INR 2.5-3.5

<2 Reload x 0-1
Increase by 5-15%
<2.5
2-3 No change 2.5-3.5
3.1-3.5 Decrease by 0-15% 3.6-4
3.6-4 Hold 0-1 dose
Decrease by 5-15%
4-4.5
>4 Hold until therapeutic
+/- minidose vitamin K
Decrease by 10-20%
>4.5

 

 

 

 

 

 

 

 

 

 

Adapted from Crowther MA, Harrison L, Hirsch L. Ann Intern Med 1997; 127:332-3