Vitamin K is available as a 10mg/ml solution. This medicine is to be used as an antidote for adult patients taking the anticoagulant (clot-preventing) medicines apixaban or rivaroxaban, when reversal of their action is needed due to life-threatening or uncontrolled bleeding. Oral vitamin K dose: The injection solution can be given orally (the 10mg tablet is not readily divided into smaller doses). Vitamin K1 (phytomenadione) is indicated as an antidote to coumarin anticoagulants (such. The current IV vitamin K preparation can be given as an IV push over 2-3 mins.Įffects of INR from IV vitamin K seen within 4 hours, for oral vitamin K 12-24 hours. What is the starting dose when warfarin treatment is initiated. If the INR falls significantly below the therapeutic range additional anticoagulant therapy should be considered for patients with a high risk of thrombosis. This protocol gives relatively aggressive reversal of warfarin. Patient with an INR above the therapeutic range with a high risk of bleedingĦ-12 hours early testing may be necessary if INR excessively above 9 or risk of bleeding assessed as very high. May offer advantage over FFP as a small volume and there is no time delay in thawing. The INR can be measured within 15mins of dose completion and doses repeated as necessary depending on the INR. WarfarinĢ5-50 IU/kg Octaplex plus 2 units of FFP if Octaplex not readily available 4 units FFP.Īssess patient continuously until both INR 5.0 use a dose closer to 50IU/kg.Īdminister at a rate of 3ml/min or as tolerated by the patient. It is for any clinically significant bleeding where warfarin induced coagulopathy is considered a contributing factor. This intervention is designed to rapidly reverse the INR in what may be life-threatening circumstances. Patient has clinically significant bleeding There is a smart phone app available to assist with managing over dose. antagonists such as warfarin, and are indicated in non-valvular atrial fibrillation and venous thromboembolism (Box 1). For warfarin-treated patients who need to undergo a semiurgent (within 2436 hours) procedure, low-dose oral vitamin K, given the day before the intervention, will often achieve sufficient INR correction and avoid the need for transfusion. If a patient has a high INR consider the following possible causesĪn elevated INR can significantly increase the risk of death from haemorrhage Smart Phone app Treatment strategy for warfarin over-anticoagulation
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