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🆎 Warfarin Reversal: Life-Threatening Bleed - #MEDSHED

Updated: Mar 10

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🆎 Warfarin Reversal: Life-Threatening Bleed - #MEDSHED

What is Warfarin?

Anticoagulant; inhibits synthesis of the vitamin K dependent clotting factors (II, VII, IX, and X)

Supportive Care

Maintain and secure ABCs

Hemorrhage source control

Blood transfusion to maintain Hgb > 7 g/dL

Vitamin K (phytonadione)

Essential for hepatic synthesis of clotting factors

Dose: 10 mg IV piggyback

Caution: avoid rapid administration, associated with severe reactions

INR correction: ~ 6 hours

KCentra (4F-Prothombin Complex Concentrate) - give with Vitamin K

Contains clotting factors II, VII, IX, X, and protein C & S; heparin

INR correction: ~ 30 minutes

Onset of vitamin K maintains hemostasis as 4F-PCC effects diminish

Institution dosing may differ than package insert recommendations

Fresh Frozen Plasma (FFP) - give with Vitamin K

Contains clotting factors II, VII, IX, and X

Dose: Initial 4 units

Longer infusion time, slower correction of INR vs 4F-PCC; alternative

INR correction: similiar efficacy to 4F-PCC at 24 hours

Caution: fluid status, infusion rxn

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