Warfarin reversal: Difference between revisions

(/* Major BleedingHolbrook 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 Prac...)
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==Background==
==Background==
#[[Vitamin K]]
*Intracranial hemorrhage is significantly increased with an INR > 4.0<ref>Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin.  Ann Intern Med.1994;120:897-902.</ref>
##Oral route is preferred over subcutaneous route: superior efficacy
 
##Intravenous route carries rare but serious risk of anaphylaxis
'''Risks Factors for INR > 6.0'''<ref>Hylek, E et al. Acetaminophen and Other Risk Factors for Excessive Warfarin Anticoagulation. JAMA. 1998;279(9):657-662 [http://jama.jamanetwork.com/data/Journals/JAMA/4550/JOC71452.pdf PDF]</ref>
##Only give for patient with:
{| class="wikitable"
###Life-threatening bleeding
| align="center" style="background:#f0f0f0;"|'''Risk Factor'''
###INR >20
| align="center" style="background:#f0f0f0;"|'''Odds Ratio'''
###Symptomatic patient poisoned by suicidal ingestion of warfarin or rodenticide
|-
| Malignancy||16.4
|-
| Tylenol Intake > 9100mg/week||10
|-
| New Medication||8.5
|-
| Incrased Warfarin Intake||8.1
|-
| Tylenol Intake 4550mg-9099mg /week||6.9
|-
| Decrease Vitamin K intake||3.6
|-
| Acute Diarrheal Illness||3.5
|}


==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>==
==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>==

Revision as of 22:54, 30 March 2014

Background

  • Intracranial hemorrhage is significantly increased with an INR > 4.0[1]

Risks Factors for INR > 6.0[2]

Risk Factor Odds Ratio
Malignancy 16.4
Tylenol Intake > 9100mg/week 10
New Medication 8.5
Incrased Warfarin Intake 8.1
Tylenol Intake 4550mg-9099mg /week 6.9
Decrease Vitamin K intake 3.6
Acute Diarrheal Illness 3.5

INR 4.5-10 No Bleeding[3]

  1. Hold Warfarin
  2. Resume Warfarin at lower dose once INR therapeutic
  3. Not recommended to give Vitamin K

INR >10 No Bleeding[4]

  1. Hold Warfarin
  2. Vitamin K 2.5 mg oral

Major Bleeding[5]

  1. Stop warfarin
  2. Give Vitamin K 5-10mg IV INR will decrease over 24-48 hours (small risk of anaphylaxis with IV Vitamin K)
  3. Give 4 Factor Prothrombin Complex Concentrate (PCC)
  4. If no PCC then give 2 unites Fresh Frozen Plasma
    1. No benefit to combining PCC and FFP

Consult cardiology in conjunction with hematology if patient has prosthetic valve

See Also

Source

  1. ↑ Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med.1994;120:897-902.
  2. ↑ Hylek, E et al. Acetaminophen and Other Risk Factors for Excessive Warfarin Anticoagulation. JAMA. 1998;279(9):657-662 PDF
  3. ↑ 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
  4. ↑ 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
  5. ↑ 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
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