Warfarin reversal

Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 PDF. For the emergent reversal of anticoagulation, there is only one dose and one route of vitamin K that should be used: 10 mg of IV vitamin K infused over 30 minutes. Whenever possible, anticoagulation should be resumed in a timely manner to avoid thromboembolic complications related to the underlying indication for anticoagulation. Vitamin K and prothrombin complex concentrate (PCCs) can be used for warfarin reversal. Andexanet alfa and idarucizumab are specific reversal agents for DOACs and DTIs, respectively. A 37-year-old man receiving warfarin for secondary prevention of venous thromboembolism presents to the emergency department with a 2-day history of melena and new massive hematemesis. Reversal of warfarin with Vitamin K should be reserved only for the most serious bleeding events or patients who will not be restarted on warfarin. Vitamin K should be administered either orally or intravenously (IV) only. Oral Vitamin K is the safest and most reliable route. Conversion to warfarin: Since dabigatran contributes to INR elevation, warfarin’s effect on the INR will be better reflected only after dabigatran has been stopped for ≥2 days. There are a significant number of patients taking anticoagulants, such as warfarin, and, increasingly, direct oral anticoagulants (DOACs). When we see patients on these medications, with uncontrolled haemorrhage, management may include the reversal of the anticoagulants, especially in major haemorrhage. Spontaneous IPH – Reversal Guide for Warfarin. Guidelines for Reversal of Anticoagulants. UW Medicine Resource: Head Injury in Anticoagulated Patients (OCCAM) Since adoption of the INR system it has been usual practice to adjust the dose of warfarin, or other oral vitamin K antagonists, to maintain the INR within therapeutic range.

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