Warfarin reversal: Difference between revisions
Ostermayer (talk | contribs) No edit summary |
Ostermayer (talk | contribs) No edit summary |
||
| Line 22: | Line 22: | ||
|} | |} | ||
==INR | ==Treatment based on INR<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=== | |||
#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=== | ||
#Hold Warfarin | #Hold Warfarin | ||
#[[Vitamin K]] 2.5 mg oral | #[[Vitamin K]] 2.5 mg oral | ||
==Major Bleeding | ===Major Bleeding=== | ||
#Stop warfarin | #Stop warfarin | ||
#Give [[Vitamin K]] 5-10mg IV INR will decrease over 24-48 hours (small risk of [[anaphylaxis]] with IV [[Vitamin K]]) | #Give [[Vitamin K]] 5-10mg IV INR will decrease over 24-48 hours (small risk of [[anaphylaxis]] with IV [[Vitamin K]]) | ||
Revision as of 22:55, 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 |
Treatment based on INR[3]
INR 4.5-10 No Bleeding
- Hold Warfarin
- Resume Warfarin at lower dose once INR therapeutic
- Not recommended to give Vitamin K
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 Vitamin 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
- ↑ Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med.1994;120:897-902.
- ↑ Hylek, E et al. Acetaminophen and Other Risk Factors for Excessive Warfarin Anticoagulation. JAMA. 1998;279(9):657-662 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