OVER-ANTICOAGULATION - WARFARIN

See Assessing severity of Bleeding

See Acceptable clotting parameters pre-operatively

BLEEDING INR TREATMENT FOLLOWUP
Life-threatening/Severe/Moderate
Pre-operative
< 4 Prothrombinex HT 25 IU/kg
FFP 2-4 units
Vitamin K 10mg IV
Repeat INR after 15-120min
Life-threatening/Severe/Moderate
Pre-operative
4-6 Prothrombinex HT 35 IU/kg
FFP 2-4 units
Vitamin K 10mg IV
Repeat INR after 15-120min
Life-threatening/Severe/Moderate
Pre-operative
> 6 Prothrombinex HT 50 IU/kg
FFP 2-4 units
Vitamin K 10mg IV
Repeat INR after 15-120min
Mild bleeding < 8 Hold warfarin Repeat INR in 24 hours
Restart at adjusted dose when INR < 5
Mild bleeding > 8 Hold warfarin
Vitamin K 2mg PO or
Vitamin K 0.5-2mg IV
Repeat INR in 12 hours

 

NB Prothrombinex is a freeze-dried product (1 bottle = 500 IU reconstituted to 20-40ml and given as bolus)

Adapted from TQEH guidelines