Warfarin Dose Reduction After Holding Two Days
After holding warfarin for 2 days due to elevated INR, you should restart at a reduced weekly dose of 10-15% lower than your previous total weekly dose, which translates to approximately 5mg daily if your prior dose was around 5.5-6mg daily. 1
Dose Adjustment Strategy
The American College of Cardiology recommends reducing the weekly warfarin dose by approximately 10-15% when restarting after holding doses for elevated INR. 1
When warfarin is resumed after holding for elevated INR, it should be restarted at a lower dose to prevent recurrence of supratherapeutic INR—specifically, the total weekly dose should be reduced by 10-20% from the previous regimen. 1
If your previous weekly dose totaled 35-42mg (approximately 5-6mg daily), reducing to 5mg daily represents an appropriate 10-15% reduction and is a reasonable restart dose. 1
Critical Monitoring Requirements
Recheck your INR within 24-48 hours after restarting warfarin to confirm appropriate response and make further adjustments if needed. 1
Continue monitoring INR every 24-48 hours until it stabilizes within the therapeutic range, as patients who have had dose interruptions require more frequent monitoring until stability is re-established. 1
The INR should be rechecked within 24-48 hours after intervention to ensure appropriate reduction and to make further dosage adjustments if needed. 1
Important Considerations
Identify and correct the factors that caused your INR elevation (drug interactions, dietary changes in vitamin K intake, intercurrent illness, medication non-adherence, or alcohol consumption) to prevent recurrence. 1
The goal is to prevent both bleeding complications from excessive anticoagulation and thrombotic events from inadequate anticoagulation—this balance requires careful dose titration. 1
Common Pitfalls to Avoid
Do not resume warfarin at your previous dose, as this will likely result in another supratherapeutic INR within days. 1
Avoid making dose adjustments based on a single INR value once stable—most changes should alter the total weekly dose by only 5-20%. 2
Do not skip the 24-48 hour INR recheck, as this is essential to confirm you're not under- or over-correcting the dose. 1