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20160425222515 Ben  
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|Situation||Management|||
||Major bleeding|Stop warfarin|Give intravenous vitamin K 5mg|Prothrombin complex concentrate - if not available then FFP|
|INR > 8.0|Minor bleeding|	Stop warfarin|Give intravenous vitamin K 1-3mg|Repeat vit K, if still high at 24h and restart warfarin when INR <5|
|INR > 8.0|No bleeding|Stop warfarin|Give oral vitamin K 1-5mg (can use IV prep orally)|Repeat vit K, if still high at 24h and restart warfarin when INR <5|
|INR 5.0-8.0|Minor bleeding|Stop warfarin|Give intravenous vitamin K 1-3mg|Restart warfarin when INR < 5.0|
|INR 5.0-8.0|No bleeding|Withhold 1 or 2 doses of warfarin||Reduce subsequent maintenance dose|