|
Part Two: Managing Warfarin
Overdosing
Managing Patients with High INR Values
- Serious Bleeding
| Clinical
Situation |
Guidelines |
| INR
>9.0, no clinically significant bleeding |
-
Vitamin K (3–5
mg orally); closely monitor the INR; if the INR
is not substantially reduced by 24–24 h, the vitamin K dose
can be repeated
-
Serious bleeding, or major warfarin overdose (e.g.,
INR >20.0) requiring very rapid reversal of anticoagulant
effect: Vitamin K (10
mg by slow IV infusion), with fresh plasma transfusion
or prothrombin complex concentrate, depending upon
urgency;vitamin K injections
may be needed q12h.
|
|
| Life-threatening
bleeding or serious warfarin overdose |
|
|
| Continuing
warfarin therapy indicated after high doses of vitamin K |
|
Notes:
If the INR is between 9 and 20;
oral Vitamin K should
be administered in a dose of 2.5 mg.
If the INR is >20 more aggressive
measures should be used. Vitamin K should be administered
by slow intravenous infusion over 10
minutes in a dose of at least 5 mg, an infusion
of fresh frozen plasma and hospitalization should be considered,
and the hematocrit checked for hidden bleeding.
If the INR is excessively out of
range and dose not make sense with the recent trend in INR
results in individual patients, the clinician is advised to
consider the possibility of laboratory error before a dose
adjustment is made. In this case, it is optimal to repeat
the INR before a dose change is made to verify the results.
If there is serious bleeding, the
patient should be hospitalized. Vitamin K should be administered
by slow intravenous infusion over 10 minutes in a dose of
5–10 mg, an infusion of fresh frozen plasma should be given
Prothrombin concentrate should be considered if bleeding is
life-threatening.
|
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