Coumadin Overdose Treatment Guidelines
INR			Patient Situation			Action
> 3.0 - < 5.0			no bleeding and no need for rapid reversal (ex surgery)			omit next dose and restart at lower dose when INR approaches 3.0
> 5.0 - < 9.0			no bleeding			if no risk for bleeding: omit next 1-2 doses, monitor INR frequently, and start at lower dose when INR approaches 3.0.  If bleeding risk: give vitamin K 1-2mg orally
> 5.0 - < 9.0			need rapid reversal (ex. surgery, dental procedure			hold coumadin and give vitamin K 2-4mg orally (INR will decrease within 24 hours).  If INR still high, give additional 1-2mg vitamin K orally
> 9.0 - < 20.0			no bleeding			hold coumadin and give vitamin K 3-5mg orally
> 20.0			serious bleeding or major coumadin overdose			hold coumadin and give vitamin K 10mg slow IV infusion with supplemental fresh transfusion of prothrombin complex depending on urgency
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