Warfarin reversal: Difference between revisions
Ostermayer (talk | contribs) |
Ostermayer (talk | contribs) (/* Excessive Anticoagulation Treatment 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 Eviden...) |
||
| Line 8: | Line 8: | ||
###Symptomatic patient poisoned by suicidal ingestion of warfarin or rodenticide | ###Symptomatic patient poisoned by suicidal ingestion of warfarin or rodenticide | ||
=Excessive Anticoagulation Treatment <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</ref>= | =Excessive Anticoagulation Treatment <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</ref>= | ||
==INR 4.5-10 No Bleeding== | ==INR 4.5-10 No Bleeding== | ||
#Hold Warfarin | #Hold Warfarin | ||
Revision as of 17:16, 28 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
Excessive Anticoagulation Treatment [1]
INR 4.5-10 No Bleeding
- Hold Warfarin
- Resume Warfarin at lower dose once INR therapeutic
INR > 10 No Bleeding
- Hold Warfarin
- Vitamin K 2.5 mg oral
Major Bleeding
- 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 http://www.siapav.it/pdf/Chest%202012.pdf