INR 2.4 within target 2.0–3.0, dose continued per protocol, no bleeding signs, no new interacting meds or major vitamin-K change. Skilled INR interpretation and daily bleeding surveillance required; supports the Section N anticoagulant day.
DOAC management
DOAC per order, renal function stable, no bleeding signs, fall precautions in place, adherence/interacting meds reviewed. Skilled bleeding and renal/adherence surveillance required; supports Section N.
LMWH bridge
Therapeutic LMWH administered per order with the platelet/renal monitoring per protocol, no bleeding signs, injection sites without hematoma. Skilled parenteral-anticoagulant administration and surveillance required; supports Section N.
