Warfarin reversal: Difference between revisions

(Created page with "Vitamin K Guidelines for Warfarin (Coumadin) Reversal== == ==Excessive Anticoagulation== ===INR < 5 No Bleeding=== 1. ↓ dose or omit dose 2. Resume at ↓ dose ...")
 
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Vitamin K Guidelines for Warfarin (Coumadin) Reversal== ==
==Background==
 
Vitamin K Guidelines for Warfarin (Coumadin) Reversal


==Excessive Anticoagulation==
==Excessive Anticoagulation==
===INR < 5 No Bleeding===
===INR < 5 No Bleeding===
 
#↓ dose or omit dose
 
#Resume at ↓ dose once INR therapeutic
1.    ↓ dose or omit dose
 
2.    Resume at ↓ dose once INR therapeutic
 


===INR 5-9 No Bleeding===
===INR 5-9 No Bleeding===
 
# Omit 1-2 doses
 
# Resume at ↓ dose once INR therapeutic
1.    Omit 1-2 doses
# Vit K 1-2.5mg po if patient is at high risk for bleeding
 
2.    Resume at ↓ dose once INR therapeutic
 
3.    Vit K 1-2.5mg po if patient is at high risk for bleeding
 
 
Reversal for patients undergoing surgery:1.    Omit dose
 
2.    Give vit K 2-4mg po
 
3.    ↓ in INR will occur in 24h
 
4.    If INR still high, may give additional Vit K 1-2mg po
 


===INR ≥ 9 No Bleeding ===
===INR ≥ 9 No Bleeding ===
# Hold warfarin
# Vit K 2.5-5mg po
# INR will ↓ in 24-48h


 
==Specific Reversal Reasons==
1. Hold warfarin
===Reversal for patients undergoing surgery===
 
# Omit dose
2. Vit K 2.5-5mg po
# Give vit K 2-4mg po
 
# ↓ in INR will occur in 24h
3. INR will ↓ in 24-48h
# If INR still high, may give additional Vit K 1-2mg po
 


===INR therapeutic or elevated with Serious Bleeding===
===INR therapeutic or elevated with Serious Bleeding===
# Hold warfarin
# Vit K 5-10mg subQ/IV
# FFP
# PCC or rFVIIa
# Vit K may be repeated q12h


==Treatment==
#Oral route for vitamin K is preferred due to superior efficacy compared to subcutaneous route. #Oral vitamin K is available in tablet and solution formulations.


1.    Hold warfarin
==Source==
 
2.    Vit K 5-10mg subQ/IV
 
3.    FFP
 
4.    PCC or rFVIIa
 
5.    Vit K may be repeated q12h
 
 
***Oral route for vitamin K is preferred due to superior efficacy compared to subcutaneous route. Oral vitamin K is available in tablet and solution formulations.
 
 
 
 
Source
 
Ansell J, Hirsh J, Poller L et al. The Pharmacology and Management of the Vitamin K Antagonists. CHEST. 126(3S):204S-233S.
Ansell J, Hirsh J, Poller L et al. The Pharmacology and Management of the Vitamin K Antagonists. CHEST. 126(3S):204S-233S.


[[Category:Heme/Onc]]
[[Category:Heme/Onc]]
[[Category:Tox]]

Revision as of 13:48, 15 March 2011

Background

Vitamin K Guidelines for Warfarin (Coumadin) Reversal

Excessive Anticoagulation

INR < 5 No Bleeding

  1. ↓ dose or omit dose
  2. Resume at ↓ dose once INR therapeutic

INR 5-9 No Bleeding

  1. Omit 1-2 doses
  2. Resume at ↓ dose once INR therapeutic
  3. Vit K 1-2.5mg po if patient is at high risk for bleeding

INR ≥ 9 No Bleeding

  1. Hold warfarin
  2. Vit K 2.5-5mg po
  3. INR will ↓ in 24-48h

Specific Reversal Reasons

Reversal for patients undergoing surgery

  1. Omit dose
  2. Give vit K 2-4mg po
  3. ↓ in INR will occur in 24h
  4. If INR still high, may give additional Vit K 1-2mg po

INR therapeutic or elevated with Serious Bleeding

  1. Hold warfarin
  2. Vit K 5-10mg subQ/IV
  3. FFP
  4. PCC or rFVIIa
  5. Vit K may be repeated q12h

Treatment

  1. Oral route for vitamin K is preferred due to superior efficacy compared to subcutaneous route. #Oral vitamin K is available in tablet and solution formulations.

Source

Ansell J, Hirsh J, Poller L et al. The Pharmacology and Management of the Vitamin K Antagonists. CHEST. 126(3S):204S-233S.

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