INR Targets in Venous Thromboembolism
The guidelines below are based on the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines for Antithrombotic Therapy and Prevention of Thrombosis (ninth edition, 2012). [1]
Acute pulmonary embolism (PE) [2, 3]
International normalized ratio (INR) target (range)
-
Standard: 2.5 (2.0-3.0)
-
Unprovoked, infrequent INR checks: 1.5-1.9 after 3 months of standard therapy
Duration of therapy
-
Transient, reversible risk factor: 3 months
-
First episode, unprovoked
Low/moderate bleeding risk: Extended therapy
High bleeding risk: 3 months
-
Recurrent, unprovoked
Low/moderate bleeding risk: extended therapy
High bleeding risk: 3 months
-
Cancer: Extended therapy
Acute deep venous thrombosis (DVT) of the lower extremity
INR target (range)
-
Standard: 2.5 (2.0-3.0)
Duration of therapy
-
Transient, reversible risk factor: 3 months
-
First episode, unprovoked, proximal
Low/moderate bleeding risk: Extended therapy
High bleeding risk: 3 months
-
First episode, unprovoked, distal: 3 months (guidelines suggest serial imaging for 2 weeks rather than early anticoagulation for patients with isolated distal lower-extremity DVT who do not have severe symptoms or risk factors for extension)
-
Recurrent, unprovoked
Low/moderate bleeding risk: Extended therapy
High bleeding risk: 3 months
-
Cancer: Extended therapy
Acute DVT of the upper extremity
INR target (range): 2.5 (2.0-3.0) [4]
Duration of therapy
-
Axillary or more proximal: 3 months or more
-
Distal: 3 months
-
Central venous catheter (CVC) related: Until catheter is removed, or a minimum of 3 months
Acute DVT in children
INR target (range) [5]
-
Standard: 2.5 (2.0-3.0)
-
CVC related: 1.5-1.9 after 3 months of standard therapy
Duration of therapy
-
Idiopathic, first episode: 6-12 months
-
Idiopathic, recurrent: Lifelong therapy
-
Reversible risk factor: Until risk factor has resolved, or a minimum of 3 months
-
Cancer, thrombophilia: Until risk factor has resolved, or a minimum of 3 months
-
CVC related: Until CVC is removed, or a minimum of 3 months