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dous inter-individual variability in warfarin dosing is apparent, necessitating frequent monitoring via the international normalized ratio (INR). The most feared complication of warfarin therapy is major bleeding, and the risk of this problem increases when the INR exceeds 4.0. 2 Critical INR values (defined in the Edmonton region of Alberta Health Services as an INR > 5.0; the definition may vary by jurisdiction) are reported urgently to clinicians to enable prompt patient management. For ambulatory patients who are not bleeding, strategies to manage critical INRs include withholding warfarin therapy, with the option of admin istering oral vitamin K 1, but guidelines vary and have changed

Warfarin Re-initiation Gone Awry: A Case of Inadvertent Overdose Mandating Critical INR Management