First-line recommendation | |
Vitamin K | INR≤2, no vitamin K |
INR 2–5, 1–3 mg IV | |
INR 5–9, 2–5 mg IV | |
INR>9, 10 mg IV | |
If INR>2 at 24 hours, repeat vitamin K | |
PCC | For INR>2, 25–50 U/kg IV |
If INR>2 after 1 hour, repeat dose | |
Second-line recommendation | |
FFP | For INR>2, 2–4 units of IV |
If INR>2 after 1 hour, repeat dose |
INR, international normalized ratio; IV, intravenous; FFP, fresh frozen plasma; PCC, prothrombin complex concentrate.