Warfarin Reversal

Question 1

What is the recommendation for INR levels between 2-4.5 with no bleeding?

Answer 1

Lower or withhold next dose of warfarin

Do not give vitamin K

Question 2

What should be done if INR is between 4.5 and 10?

Answer 2

Withhold warfarin; consider oral or intravenous vitamin K if bleeding risk is high

Vitamin K can be used to reverse warfarin effects

Question 3

What is the treatment for INR levels greater than 10 with no bleeding?

Answer 3

Withhold warfarin; give oral or intravenous vitamin K 3-5mg IV/PO

Consider adding Prothrombinex-VF if bleeding risk is high

Question 4

What is the protocol for life-threatening bleeding with INR greater than 1.5?

Answer 4

Withhold warfarin; administer IV vitamin K 5-10mg, Prothrombinex-VF 50 units/kg, and Fresh frozen plasma 300ml

Question 5

What should be done for significant bleeding that is not life-threatening with INR greater than 2?

Answer 5

Withhold warfarin; give IV vitamin K and Prothrombinex-VF

Substitute fresh frozen plasma if Prothrombinex-VF is unavailable

Question 6

What is the recommendation for minor bleeding with any INR?

Answer 6

Withhold warfarin; consider vitamin K if INR >4.5

Use 1-2mg PO or 0.5-1mg IV of vitamin K

Question 7

What is the guideline for using vitamin K if warfarin is to be restarted after a bleeding episode?

Answer 7

Use the lowest possible dose of vitamin K

PCC is much more important than FFP