Goodnough et al outlined a protocol for rapid reversal of a prolonged INR as a result of warfarin therapy or severe vitamin K deficiency. The authors are from Washington University and Barnes-Jewish Hospital in St. Louis.
Patient selection: markedly prolonged INR
Resources:
(1) vitamin K
(2) fresh frozen plasma
(3) recombinant Factor VIIa (rFVIIa)
Bleeding Status
Management
none or minimal
10 mg vitamin K, intravenous or subcutaneous, discontinue warfarin therapy
mild to moderate
10 mg vitamin K IV, FFP 15-20 mL per kg, discontinue warfarin therapy
life threatening, intracranial
10 mg vitamin K IV, FFP 15-20 mL per kg, rFVIIa 20 µg/kg IV (dosage range for rFVIIa 20-90 µg/kg) , discontinue warfarin therapy
where:
• rFVIIa therapy should only be used when absolutely necessary due to cost ($1,500+ per milligram).
• Administration of rFVIIa alone will not provide the other factors necessary for hemostasis (Factors II, IX, X).
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