Warfarin reversal

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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 [1]

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

Consult cardiology in conjunction with hematology if patient has prosthetic valve

See Also

Source

  1. 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