MSRA: Warfarin & INR

Question 1

What action needs to be taken if:

The INR is less than 6, but 0.5 above target?

Answer 1

Stop Warfarin or reduce the dose until INR less than 5

Question 2

What action needs to be taken if:

The INR is greater than 6 with no bleeding/minor bleeding?

Answer 2

Stop Warfarin, and restart when INR less than 5

If bleeding risk factors, Vit K 1-3mg
Repeat Vit K if INR still elevated after 24 hours

Question 3

What action needs to be taken if:

Major bleeding

Answer 3

Stop Warfarin
Give Vit K 5mg IV
PCC

Question 4

What is the reversal agent for Rivaroxaban and Apixaban?

Answer 4

Andexanet

Question 5

What is the reversal agent for Dabigatran?

Answer 5

Idarucizumab