Haematology

Question 1

How should we manage warfarin tx when there is a major bleed?

Answer 1

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

*as FFP can take time to defrost prothrombin complex concentrate should be considered in cases of intracranial haemorrhage

Question 2

How should we manage warfarin tx when there INR > 8.0
+ Minor bleeding?

Answer 2

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

Question 3

How should we manage warfarin tx when there INR > 8.0
+ no bleeding?

Answer 3

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

Question 4

How should we manage warfarin tx when there INR 5.0-8.0
+ minor bleeding?

Answer 4

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

Question 5

How should we manage warfarin tx when there INR 5.0-8.0
+ no bleeding?

Answer 5

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose