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Therapeutic range (INR) Treatment of atrial fibrillation Treatment of deep vein thrombosis Pulmonary embolism Transient ischaemic attacks Antiphospholipid syndrome |
} |
Target 2.5 (2.0 - 3.0) |
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Recurrent deep vein thrombosis Occurring during Warfarin treatment Mechanical cardiac prosthetic valves |
} |
Target 3.5 (3.0 - 4.0) |
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Tissue heart valves Peripheral arterial disease |
} |
not indicated |
Reversal of oral anticoagulant therapy
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INR 6 - 7 INR 7 - 10 INR >10 INR >7
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Without haemorrhage, withhold A/C until INR 5 then reduce dose. Without haemorrhage, withhold A/C. Oral Vitamin K, 1-2mg. Without or minor haemorrhage, withhold A/C. i.v. Vit. K, 2mgs. Major haemorrhage-fresh frozen plasma, 15ml/kg(3 units =@700mls) i.v. Vit. K - 5mgs and consider Factor IX concentrate (DEFIX), 10 units/kg. Please contact Haematology M.O. Life threatening haemorrhage Vit. K 5mgs i.v. (slow infusion) and Factor IX concentrate, (DEFIX) 10 - 20 i.u./Kg body weight. Repeat INR after 4 hours.
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High dose Vit. K (>5mgs) induces coumarin resistance for at least 3 days. Vitamin K i.v. may produce an anaphylactic reaction and must be given slowly! e.g. in 100mls saline over 10 mins.