Suggested algorithm for reversing VKAs in nonbleeding patients with an INR above the therapeutic range. For patients with a single INR of ≤0.5 above the therapeutic range, the VKA dose should remain unchanged. *With acenocoumarol, consider merely reducing the dose because stopping may result in INR overcorrection. **With acenocoumarol, stopping for more than 1 day may result in INR overcorrection. ^§Patients with older age, heart failure, cancer, or longer acting VKA.