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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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