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 Treatment

INR 4.5-10 No Bleeding

1. Hold Warfarin
2. Resume Warfarin at lower dose once INR therapeutic
3. Not recommended to give Vitamin K

INR > 10 No Bleeding

1. Hold Warfarin
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

Consult cardiology in conjunction with hematology if patient has prosthetic valve

See Also

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