Atrial Fibrillation/INR

A 68-year-old with atrial fibrillation is taking warfarin as part of therapy for the prevention of thromboembolic event.  His goal INR is 2-3, which is checked monthly and has been within acceptable range for the past 6 months. Today he presents with an INR=3.8. He denies bleeding events and reports, “I am taking my medicine just like I was told.” The NP considers that:

A. The INR should be repeated today.
B. A single dose of injectable vitamin K should be ordered.
C. His health history should be reviewed carefully, with a focus on interacting with medications and/or foods.
D.   His weekly warfarin dose should be increased by 15%.

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