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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Emergency reversal of anticoagulation from warfarin for life-threatening hemorrhage in adults: Suggested approaches based upon available resources

Emergency reversal of anticoagulation from warfarin for life-threatening hemorrhage in adults: Suggested approaches based upon available resources
  1. If 4-factor prothrombin complex concentrate (4F PCC) is available (preferred approach):
  1. Give 4F PCC* 1500 to 2000 units IV over 10 minutes. Check INR 15 minutes after completion of the infusion. If INR is not ≤1.5, give additional 4F PCC (refer to topic or drug reference for details).
  2. Give vitamin K 10 mg IV over 10 to 20 minutes.
  1. If 3-factor prothrombin complex concentrate (3F PCC) is available but 4F PCC is not available:
  1. Give 3F PCC* 1500 to 2000 units IV over 10 minutes. Check INR 15 minutes after completion of the infusion. If INR is not ≤1.5, give additional 3F PCC (refer to topic or drug reference for details).
  2. Give Factor VIIa 20 mcg/kg IV or give FFP 2 units IV by rapid infusion. Factor VIIa may be preferred if volume overload is a concern.
  3. Give vitamin K 10 mg IV over 10 to 20 minutes.
  1. If neither 3F PCC nor 4F PCC is available:
  1. Give FFP 2 units IV by rapid infusion. Check INR 15 minutes after completion of infusion. If INR ≥1.5, administer 2 additional units of FFP IV rapid infusion. Repeat process until INR ≤1.5. May wish to administer loop diuretic between FFP infusions if volume overload is a concern.
  2. Give vitamin K 10 mg IV over 10 to 20 minutes.

These products and doses are for use in life-threatening bleeding only. Evidence of life-threatening bleeding and over-anticoagulation with a vitamin K antagonist (eg, warfarin) are required. Anaphylaxis and transfusion reactions can occur.

It may be reasonable to thaw 4 units of FFP while awaiting the PT/INR. The transfusion service may substitute other plasma products for FFP (eg, Plasma Frozen Within 24 Hours After Phlebotomy [PF24]); these products are considered clinically interchangeable. PCC will reverse anticoagulation within minutes of administration; FFP administration can take hours due to the volume required; vitamin K effect takes 12 to 24 hours, but administration of vitamin K is needed to counteract the long half-life of warfarin. Subsequent monitoring of the PT/INR is needed to guide further therapy. Refer to topics on warfarin reversal in individual situations for further management.

FEIBA: factor eight inhibitor bypassing agent; FFP: fresh frozen plasma; INR: international normalized ratio; PCC: unactivated prothrombin complex concentrate; PT: prothrombin time; 3F PCC: PCC containing factors II, IX, and X and only trace factor VII; 4F PCC: PCC containing coagulation factors II, VII, IX, X, protein S and protein C.

* Before use, check product label to confirm factor types (3 versus 4 factor) and concentration. Activated complexes and single-factor IX products (ie, FEIBA, AlphaNine, Mononine, Immunine, BeneFix) are not used for warfarin reversal.

¶ PCC doses shown are those suggested for initial treatment of emergency conditions. Subsequent treatment is based on INR and patient weight if available. Refer to topic and Lexicomp drug reference included with UpToDate for INR-based dosing.
Graphic 89478 Version 11.0

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