Management of overanticoagulation See p522 for details Asymptomatic patient

INR >5.0—stop warfarin and reduce dose by at least 25%. Check INR within 1 week.

INR >8.0—consider oral vitamin K 1-5mg. Symptomatic patient

Moderate bleeding, INR 5.0-8.0, give vitamin K 1mg slowly IV. INR >8.0: give vitamin K 1mg and FFP or factor concentrate. Severe bleeding: vitamin K 5mg IV, and concentrate containing factors II, VII, IX and X (e.g. beriplex). Observe in hospital. Vitamin K reverses over-anticoagulation in 24h. Look for causes of over-anticoagulation e.g. heart failure, alcohol, drugs.

Kearon, C. & Hirsh, J. (1997) Management of anticoagulation before and after elective surgery. N Engl J Med, 336, 1506-1511.

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