Management of patients on Warfarin with bleeding
Clinical setting |
Recommendation |
INR >1.5 with life-threatening
(critical organ) bleeding |
Cease Warfarin
Administer:
·
Vitamin K 5.0 – 10.0 mg i.v.
·
and Prothrombinex-VF 50 IU/kg i.v.
·
and fresh frozen plasma 150 – 300 ml i.v.
·
If prothrombinex-VF is unavailable administer fresh
frozen plasma 15ml/kg |
INR >2.0 with clinically significant bleeding |
Cease Warfarin
Administer:
·
Vitamin K 5.0 – 10.0 mg i.v.
·
and Prothrombinex-VF 35 - 50 IU/kg i.v. according to INR (see table below).
If Prothrombinex-VF is unavailable administer fresh
frozen plasma 15ml/kg |
Any INR with minor bleeding |
Omit Warfarin
Repeat INR next day and adjust dose to maintain INR
within the therapeutic range.
If the bleeding risk is high or INR >4.5 consider vitamin
K 1.0 – 2.0 mg orally or 0.5 – 1.0mg iv. |
Re
Suggested dose of Prothrombinex-VF to reverse Warfarin according to the initial
and target INR
Prothrombinex-VF is available in 500iu vials.
|
Initial INR |
|||
Target INR |
1.5 – 2.5 |
2.6 – 3.5 |
3.6 – 10.0 |
>10.0 |
0.9 – 1.3 |
30 IU/kg |
35 IU/kg |
50 IU/kg |
50 IU/kg |
1.4 – 2.0 |
15 IU/kg |
25 IU/kg |
30 IU/kg |
40 IU/kg |