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Flashcards in Bleeding Deck (16)
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If a patient on warfarin has major bleeding, regardless of INR, what should they receive?

PCC OR FFP + IV vitamin K


If a patient on warfarin has no major bleeding and INR is > 10, what should they receive?

IV or PO vitamin K


Vitamin K IV to PO effectiveness ratio

1 mg IV = 5 mg PO


What does tranexamic acid do?

It inhibits fibrinolysis and is therefore used to decrease bleeding in an emergent situation (non-specific blood thickener)

Aminocaproic acid has a similar mechanism of action


Indication for recombinant factor seven (rFVIIa)

For patients who decline blood products
To enable hemostasis by activating the extrinsic clotting pathway
Salvage strategy as rate of thrombosis is high


Which oral anticoagulants are not dialyzable?

Warfarin, Rivaroxaban, and Edoxaban
Apixaban has minimal dialyzability


When to Not use vitamin K for warfarin reversal?

Intracranial hemorrhage with suspicion of cerebral venous thrombosis


When to get an INR after PCC infusion is started

24 - 48 hours after PCC
If INR >/= 1.4, give IV vitamin K + 4 - 6 units of FFP
If INR < 1.4, check INR every 4 hours for 24 hours


Do not administer protamine for LMWH if last dose of LMWH was how many hours ago

greater than 12 hours


What initial diagnostic tests are used to distinguish intracerebral hemorrhage (ICH) from ischemic stroke?



What mechanical DVT prophylaxis should be used for patients with intracerebral hemorrhage and when?

Intermittent pneumatic compression starting the day of hospital admission


What pharmacologic prophylaxis should be used for patients with intracerebral hemorrhage and when?

LMWH or UFH after documented cessation of bleeding, 1 - 4 days from onset


When is the optimal time to resume oral anticoagulation after anticoagulant related ICH?

Uncertain, but avoidance of oral anticoagulation for at least 4 weeks in patients without mechanical heart valves may decrease risk
Per EurHeart 2016, "After intracranial haemorrhage, oral anticoagulation in patients with AF may be reinitiated after 4-8 weeks provided the cause of bleeding or the relevant risk factor has been treated or controlled."


Preferred agents if patient has a high risk of GI bleeding

warfarin or apixaban


Dose of FFP for VKA associated bleeding

10 - 15 mL/kg IV
Usually 4 - 6 units


Dose of 4F-PCC for VKA associated bleeding
INR 1.5 - 3.9
INR 4.0 - 6.0
INR > 6.0

INR 1.5 - 3.9: 25 units/kg
INR 4.0 - 6.0: 35 units/kg
INR > 6.0: 50 units/kg
Units based on amount of factor IX

Max dosing weight 100 kg
Consider upfront dose of 500 - 1000 units to expedite care