Anticoagulation Reversal Flashcards
Warfarin reversal when INR 6 - 10 without active bleeding
Vit K 2.5 - 5 mg PO or 0.5 - 1 mg IV
However, Vit K is not recommended in this group per CHEST guidelines (trick question!)
Warfarin reversal prior to invasive procedure when INR is 1.4 - 1.9
Vit K 1 mg PO
Warfarin reversal when major bleeding
Vit K 5 - 10 mg IV
When to check INR if warfarin reversal for major bleeding
Repeated every 6 - 12 hours
Vitamin K IV rate to avoid anaphylactoid reaction
Not exceeding 1 mg/min, recommended to be mixed with at least 50 mL of IV fluid and administered over 20 - 30 mins
To avoid rebound coagulopathy, administer this with FFP or PCC
Vitamin K replacement
Helps the body make its own coagulation factors as warfarin has a long half life
Risks, limitations, and therefore potential adverse effects of fresh frozen plasma
ABO group specificity (immunogenicity), transmitting bloodborne pathogens (infections), thawing (delay and therefore more bleeding), allergic reactions (urticaria, anaphylaxis), transfusion related acute lung injury, large volumes (edema, intravascular volume overload)
FFP dose
10 - 20 mL/kg
Kcentra dose for warfarin reversal if INR 4.0 - 6.0
> 35 IU/kg
Kcentra dose for warfarin reversal if INR > 6.0
> 50 IU/kg
Kcentra should be avoid in this group because of what it contains
Heparin induced thrombocytopenia because it contains heparin
Vitamin K onset of action: IV vs. PO
IV 1 - 2 hours vs. PO 6 - 10 hours
Vitamin K dosage form and administration route
5 mg PO, 100 mcg PO, 1 mg/0.5 mL IV, 10 mg/mL IV
Kcentra dosage form and administration route
100 units IV, 500 units IV
Kcentra adverse effects
Hypersensitivity, hypotension, headache, thrombosis if no vitamin K
