Warfarin anticoagulation reversal: management of the asymptomatic and bleeding patient.
The management of patients with supra-therapeutic INR in a common clinical problem. The risk of bleeding is influenced by the intensity, variability and duration of anticoagulation, patient age, presence of co-morbidities and concomitant drug therapy. For the asymptomatic patient, warfarin discontinuation is all that is usually required but for individuals at high risk of bleeding and those with INR > 10, oral vitamin K administration is recommended. In the presence of major bleeding, treatment with intravenous vitamin K and prothrombin complex concentrate is the most effective therapy.
Makris
Michael
M
Sheffield Haemophilia and Thrombosis Centre, University of Sheffield, Sheffield, UK. m.makris@sheffield.ac.uk
van Veen
Joost J
JJ
Maclean
Rhona
R
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects*; D001779:Blood Coagulation Factors / Q000008:administration & dosage; D003029:Coagulants / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D015942:Factor VIIa / Q000008:administration & dosage; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D019934:International Normalized Ratio; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000008:administration & dosage; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D003029:Coagulants; D011994:Recombinant Proteins; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin; C103587:recombinant FVIIa; D015942:Factor VIIa