Concurrent administration of intravenous Vitamin K to ensure ongoing hemostasis after the effects of PCCs wear off (usually after six hours).Immediate replacement of clotting factors with prothrombin complex concentrates (PCC).The urgent reversal of warfarin should always include: Vitamin K antagonists inhibit vitamin K-dependent synthesis of coagulation factors II, VII, IX and X and of the endogenous anticoagulation factors proteins C and S. In extensive life-threatening exsanguination, massive transfusion protocols may also be relevant but this has been discussed in a previous article.

Any patient with major bleeding, intracranial hemorrhage, or a need for urgent surgery should receive targeted reversal agents to reduce bleeding. Patients have an elevated risk for bleeding when INR values go above the target of 2.0-3.0. Main Textĭetermining the need for warfarin reversal can be challenging, but in cases of major bleeding reversal is clearly indicated. Her hemoglobin has dropped from her baseline at 140 to 95 and her INR is 3.8. She also has CAD and had two drug eluting stents placed 4 years ago but is no longer on dual antiplatelet therapy. She has atrial fibrillation and is on long-term warfarin for stroke prevention. You are in the emergency department seeing an 89-year-old female presenting with five episodes of coffee ground emesis over the last twenty-four hours. All the content from the Blood & Clots series can be found here.ĬanMEDS Roles addressed: Medical Expert Case Description

Warfarin antidote