Warfarin reversal: Difference between revisions
Ostermayer (talk | contribs) (precaution) |
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==Major Bleeding == | ==Major Bleeding == | ||
Revision as of 07:57, 5 February 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 ≤ 10 No Bleeding
- Hold Coumadin
- Resume Coumadin at lower dose once INR therapeutic
INR > 10 No Bleeding
- Hold Coumadin
- 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