Warfarin/INR

Question 1

What is the management of major bleeding in warfarinised patients?

Answer 1

Stop warfarin
Give IV vitamin K 5mg
Give prothrombin complex concentrate- if not available give FFP

Question 2

What is the management of those with a INR >8 and minor bleeding?

Answer 2

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

Question 3

What is the management of those with a INR >8.0 and no bleeding?

Answer 3

Stop warfarin
Give PO vitamin K 1-5mg
Restart when INR <5.0

Question 4

What is the management of those with a INR 5.0-8.0 and with minor bleeding?

Answer 4

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

Question 5

What is the management of those with a INR 5.0-8.0 with no bleeding?

Answer 5

Withhold 1 or 2 doses of warfarin

Question 6

What clotting factors does warfarin act on?

Answer 6

1972 and protein C

Question 7

What are the indications for warfarin and what are their target INR’s?

Answer 7

VTE: target INR 2.5
AF: target INR 2.5

Question 8

What factors can potentiate the effect of warfarin?

Answer 8

Liver disease

P450 enzyme inhibitors (amiodarone, ciprofloxacin, cranberry juice)