Warfarin over anticoagulation resident survival guide

Revision as of 14:18, 13 December 2013 by Rim Halaby (talk | contribs)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to navigation Jump to search

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]

WikiDoc Resources for Warfarin over anticoagulation resident survival guide

Articles

Most recent articles on Warfarin over anticoagulation resident survival guide

Most cited articles on Warfarin over anticoagulation resident survival guide

Review articles on Warfarin over anticoagulation resident survival guide

Articles on Warfarin over anticoagulation resident survival guide in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Warfarin over anticoagulation resident survival guide

Images of Warfarin over anticoagulation resident survival guide

Photos of Warfarin over anticoagulation resident survival guide

Podcasts & MP3s on Warfarin over anticoagulation resident survival guide

Videos on Warfarin over anticoagulation resident survival guide

Evidence Based Medicine

Cochrane Collaboration on Warfarin over anticoagulation resident survival guide

Bandolier on Warfarin over anticoagulation resident survival guide

TRIP on Warfarin over anticoagulation resident survival guide

Clinical Trials

Ongoing Trials on Warfarin over anticoagulation resident survival guide at Clinical Trials.gov

Trial results on Warfarin over anticoagulation resident survival guide

Clinical Trials on Warfarin over anticoagulation resident survival guide at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Warfarin over anticoagulation resident survival guide

NICE Guidance on Warfarin over anticoagulation resident survival guide

NHS PRODIGY Guidance

FDA on Warfarin over anticoagulation resident survival guide

CDC on Warfarin over anticoagulation resident survival guide

Books

Books on Warfarin over anticoagulation resident survival guide

News

Warfarin over anticoagulation resident survival guide in the news

Be alerted to news on Warfarin over anticoagulation resident survival guide

News trends on Warfarin over anticoagulation resident survival guide

Commentary

Blogs on Warfarin over anticoagulation resident survival guide

Definitions

Definitions of Warfarin over anticoagulation resident survival guide

Patient Resources / Community

Patient resources on Warfarin over anticoagulation resident survival guide

Discussion groups on Warfarin over anticoagulation resident survival guide

Patient Handouts on Warfarin over anticoagulation resident survival guide

Directions to Hospitals Treating Warfarin over anticoagulation resident survival guide

Risk calculators and risk factors for Warfarin over anticoagulation resident survival guide

Healthcare Provider Resources

Symptoms of Warfarin over anticoagulation resident survival guide

Causes & Risk Factors for Warfarin over anticoagulation resident survival guide

Diagnostic studies for Warfarin over anticoagulation resident survival guide

Treatment of Warfarin over anticoagulation resident survival guide

Continuing Medical Education (CME)

CME Programs on Warfarin over anticoagulation resident survival guide

International

Warfarin over anticoagulation resident survival guide en Espanol

Warfarin over anticoagulation resident survival guide en Francais

Business

Warfarin over anticoagulation resident survival guide in the Marketplace

Patents on Warfarin over anticoagulation resident survival guide

Experimental / Informatics

List of terms related to Warfarin over anticoagulation resident survival guide

Overview

There are several protocols to follow when attempting to correct the effects of over-anticoagulation with warfarin. Generally, the most important initial step is to stop the warfarin, and to continue to check the INR for its return to therapeutic levels. The additional steps are dependent upon the value of the INR, whether the patient is at a high risk of bleeding, and whether they are actively bleeding. Actively bleeding patients who have a supratherapeutic INR level will require more aggressive measures to prevent complications or death.

Treatment of Over-anticoagulation of Warfarin

Supratherapeutic INR Without Bleeding

INR less than 5

  • Decrease dose or hold warfarin.
  • Recheck INR in 24 hrs.
  • Restart warfarin at a decreased dose when INR is within target therapeutic range.

INR 5 to 9

  • Follow the same steps as above (algorithm of INR less than 5).
  • An alternative option is to hold 1-2 doses of warfarin and give vitamin K 2.5 mg PO in high risk patients.
  • Patients who have a high risk of bleeding, or who are undergoing surgery, should be given vitamin K 2.5 mg PO or a 5 mg PO.

INR > 9

  • Follow the same steps as above (algorithm of INR 5-9).
  • Can repeat Vitamin K in 24 hours if necessary.

Supratherapeutic INR with Bleeding

Therapeutic Options

Vitamin K

  • Oral vitamin K tablets are available. The lowest dose is 2.5 mg.
  • The oral route preferred over subcutaneous route due to its high efficacy.
  • Vitamin K should never be given via intramuscular route or IV push.
  • If IV route is necessary it should be IV piggyback.

Fresh Frozen Plasma

  • Dose = 15 ml/kg
  • If INR is therapeutic, a dose of 5-8 ml/kg is sufficient.

Prothrombin Complex Concentrate

  • Used in addition to FFP.
  • Dose = 25-50 units/kg

Recombinant Factor VIIa (Novoseven)

  • Used in addition to FFP
  • Dose = 40 mcg/kg

References

Template:WH Template:WS