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Flashcards in Anticoagulation Reversal Deck (17)
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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


Protamine sulfate dosing per ___ units of heparin or anti-Xa units of LMWH if within __ hours

100 units; 8 hours


Alteplase contraindications

Brain hemorrhage, active internal bleeding, brain surgery within 3 months, serious head trauma within 3 months, uncontrolled hypertension, bleeding diathesis