Warfarin reversal

Background

1. Vitamin K
   1. Oral route is preferred over subcutaneous route: superior efficacy
   2. Intravenous route carries rare but serious risk of anaphylaxis
   3. Only give for patient with:
      1. Life-threatening bleeding
      2. INR >20
      3. Symptomatic patient poisoned by suicidal ingestion of warfarin or rodenticide

Excessive Anticoagulation

INR ≤ 10 No Bleeding

1. Hold Coumadin
2. Resume Coumadin at lower dose once INR therapeutic

INR > 10 No Bleeding

1. Hold Coumadin
2. Vitamin K 2.5 mg oral

Major Bleeding

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

(no benefit to combining PCC and FFP

See Also

• Coagulopathy (Main)
• Warfarin (Coumadin)
• Dabigatran Reversal

Source

Tintinalli