Bleeding dyscrasia

Question 1

Describe how to reverse oral anticoagulants in someone with active life threatening bleeding

Answer 1

Warfarin
#no bleeding and INR less than 4.5
– lower or with-hold next dose do not given vit k
#No bleeding INR between 4.5-10
-if no high bleeding risk withold warfarin
-if bleeding risk is high ( major surgery wihtin the last 4 weeks, surgery within the last 2 weeks, platelets <50, iver disease, concurrent antiplatlets) give vit k 1-2mg orally
# no bleeding but INR >10
-give 3-5mg of oral or IV vit K (no bleeding risk)
-Consider adding 15-30 IU/kg of prothombinex if high bleeding risk
# life threatening bleeding with INR 1.5 or higher
- Vit k 5-10mg IV + Prothrombinex 50IU/K IV + FFP 150-300mls

Dabigatrin
#management of bleeding and overanticoaugaltion
-5G IV idarucizumab

Rivaroxaban/apixaban

• nil reversal and not dialysable
• use prothombinex 50IU/KG or FFP