[CK] Warfarin reversal addon. FFP 2units vs 4 units <-> preferred PCC (units per INR) + Vitamin K 10mg IV infusion. Recheck INR in 1hour(30minutes for PCC)

RECOMMENDATIONS • Level 1 Fresh Frozen Plasma (FFP) should be used for emergent reversal of elevated INRs. • Level 2 Dosing of phytonadione (Vitamin K) should be based on the patient’s current INR, risk of bleeding, and future need for anticoagulation (Tables 1 & 2). Reversal of warfarin with Vitamin K should be reserved only for the most serious bleeding events or patients who will not be restarted on warfarin. Vitamin K should be administered either orally or intravenously (IV) only. Oral Vitamin K is the safest and most reliable route. IV Vitamin K should be reserved for rapid reversal in serious bleeding events only. Subcutaneous and intramuscular administration of Vitamin K should be avoided. • Level 3 Initial dose of FFP based on risk of bleeding: Low to moderate risk – FFP 2 units High risk or active bleeding – FFP 4 units INR should be rechecked 1 hour after administration of FFP. Prothrombin Complex Concentrate (PCC) should be administered to patients on warfarin with an INR >2 AND evidence of intracranial hemorrhage on CT scan (Table 3). FEIBA NF 1000 units (one vial) IV push over 5 minutes Check INR 30 minutes after administration Vitamin K should not be administered to patients with prosthetic heart valves, only low doses (1mg) should be used if absolutely necessary. The use of recombinant Factor VIIa may be consider