What to do when warfarin therapy goes too far.
Warfarin is certainly a lifesaver--but it can also lead to potentially fatal hypocoagulability. Here we recommend best reversal options based on the type of bleed. For patients with an elevated international normalized ratio (INR) with mild or no bleeding, withhold the warfarin and recheck INR in 1 to 2 days; if INR >5, add oral vitamin K supplementation. For major bleeding and elevated INR, hospital admission, vitamin K, fresh frozen plasma, and frequent monitoring are needed. Emergent situations call for hospitalization, clotting factor replacement, and vitamin K administered by slow intravenous infusion.
Prasad
Shailendra
S
Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA. pras0054@umn.edu
Wootten
Michael R
MR
Kulinski
Nichole
N
Chapman
Scott A
SA
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D016913:Blood Component Transfusion; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005194:Family Practice / Q000592:standards* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010949:Plasma; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D015996:Survival Rate; D014812:Vitamin K / Q000627:therapeutic use*; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin