International Normalized Ratio (INR) Targets: Venous Thromboembolism 

Updated: Jul 01, 2014
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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)

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)

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)

  • 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