UMEM Educational Pearls

Category: Vascular

Title: Reversal of Warfarin

Keywords: Warfarin (PubMed Search)

Posted: 10/27/2008 by Rob Rogers, MD (Updated: 10/18/2019)
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Reversal of Warfarin

Reversal of Warfarin can be accomplished by administering any of the following:

  • Fresh Frozen Plasma (traditional reversal agent)
  • Vitamin K (po, sub q, or IV)
  • Prothrombin Complex Concentrates (PCC)-not yet available for use in the US (yet)

A few pearls:

  • It doesn't take many units of FFP to lower someone's INR
  • Don't forget volume considerations if you use FFP
  • Vit K is pretty well tolerated but some patients will have an allergic reaction (more common with IV administration)
  • These medications in general will be used for life-threatening bleeding (GI, CNS bleeds, retroperitoneal bleeds, etc)
  • Prothrombin Complex Concentrates-rich in factors 2,7,9, and 10...perfect drug since Warfarin depletes these factors
  • PCC associated with some increased thrombosis