Warfarin reversal: Difference between revisions
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=Background= | ==Background== | ||
#[[Vitamin K]] | #[[Vitamin K]] | ||
##Oral route is preferred over subcutaneous route: superior efficacy | ##Oral route is preferred over subcutaneous route: superior efficacy | ||
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###Symptomatic patient poisoned by suicidal ingestion of warfarin or rodenticide | ###Symptomatic patient poisoned by suicidal ingestion of warfarin or rodenticide | ||
= | ==INR 4.5-10 No Bleeding<ref>Holbrook A, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 [http://www.siapav.it/pdf/Chest%202012.pdf PDF]</ref>== | ||
#Hold Warfarin | #Hold Warfarin | ||
#Resume Warfarin at lower dose once INR therapeutic | #Resume Warfarin at lower dose once INR therapeutic | ||
#Not recommended to give Vitamin K | #Not recommended to give Vitamin K | ||
==INR > 10 No Bleeding== | ==INR > 10 No Bleeding<ref>Holbrook A, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 [http://www.siapav.it/pdf/Chest%202012.pdf PDF]</ref>== | ||
#Hold Warfarin | #Hold Warfarin | ||
#[[Vitamin K]] 2.5 mg oral | #[[Vitamin K]] 2.5 mg oral | ||
==Major Bleeding == | ==Major Bleeding<ref>Holbrook A, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 [http://www.siapav.it/pdf/Chest%202012.pdf PDF]</ref>== | ||
#Stop warfarin | #Stop warfarin | ||
#Give [[Vitamin K]] 5-10mg IV INR will decrease over 24-48 hours (small risk of anaphylaxis with IV Vit K) | #Give [[Vitamin K]] 5-10mg IV INR will decrease over 24-48 hours (small risk of anaphylaxis with IV Vit K) | ||
Revision as of 18:51, 29 March 2014
Background
- Vitamin K
- Oral route is preferred over subcutaneous route: superior efficacy
- Intravenous route carries rare but serious risk of anaphylaxis
- Only give for patient with:
- Life-threatening bleeding
- INR >20
- Symptomatic patient poisoned by suicidal ingestion of warfarin or rodenticide
INR 4.5-10 No Bleeding[1]
- Hold Warfarin
- Resume Warfarin at lower dose once INR therapeutic
- Not recommended to give Vitamin K
INR > 10 No Bleeding[2]
- Hold Warfarin
- Vitamin K 2.5 mg oral
Major Bleeding[3]
- Stop warfarin
- Give Vitamin K 5-10mg IV INR will decrease over 24-48 hours (small risk of anaphylaxis with IV Vit K)
- Give 4 Factor Prothrombin Complex Concentrate (PCC)
- If no PCC then give 2 unites Fresh Frozen Plasma
- (no benefit to combining PCC and FFP
Consult cardiology in conjunction with hematology if patient has prosthetic valve
See Also
Source
- ↑ Holbrook A, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 PDF
- ↑ Holbrook A, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 PDF
- ↑ Holbrook A, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 PDF