Anticoagulation Overdose

Question 1

What are the subjective findings associated with an anticoagulation overdose?

Answer 1

Severe hemorrhage

Question 2

What lab/diagnostic tests are associated with anticoagulant overdoses?

Answer 2

• Heparin: increased activated partial thromboplastin time more than 70 seconds place the patient at risk for spontaneous bleeding.
• Warfarin: with therapeutic therapy, the goal INR can range from 2-3.5 depending on the condition that is treated. Adverse effects may vary widely amount patients depending on their clinical status and need for anticoagulation.

Question 3

How do you manage a heparin overdose?

Answer 3

• Discontinuation is usually sufficient to restore normal hemostasis.
• With moderate to severe bleeding: FFP.
• Protamine Sulfate IVPB over 15-30 minutes.
• Monitor signs and symptoms of bleeding and activated partial thromboplastin time until normal

Question 4

How do you manage a warfarin overdose?

Answer 4

• Asymptomatic INR elevations < 5 should be managed with holding or reducing warfarin dose until the INR returns to the appropriate range, then resume at a lower dose.
• INR 5 – 9 and asymptomatic patient hold warfarin and monitor patients for bleeding.
• Vitamin K can be given if there is a concern for hemorrhage but holding warfarin is generally sufficient.
  
  • Know the patient’s co-morbidities and compliance when making this decision.
• For severe elevations (> 9) Vitamin K IM, PO, SQ, IVPB in doses of 2.5 to 10 mg until INR is normalized. Can give fresh frozen plasma or whole blood if indicated