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What is Urgent reversal of warfarin therapy can be done by administration of- and explain in detail?
Ans. is 'c' i.e., Fresh frozen plasma Management of warfarin induced bleeding ( Goodman & Gilman 11th/ e p. 1478) o Management of warfarin induced bleeding is guided by clinical state and INR. INR is < 5 but above therapeutic range -'Temporarily discontinue warfarin and restart at a lower dose once the INR is within the therapeutic range. If INR is between 5 - 9 - Vitamin K1 (phytonadione) at 1-2.5 mg oral. INR is between 9-20 - Vitamin K1 at 5 mg oral. If INR is >20 or serious bleeding -Immediate hemostatic competence is necessary. Fresh frozen plasma is transfused immediately supplemented with 10 mg vit Kt intravenous. Fresh frozen plasma replenishes the vit K dependent factor immediately. Alternative to fresh frozen plasma, fresh blood transfusion (supplies clotting factors) or prothrombin complex concentrate (containing factor II, IX and X) can be used. This treatment renders the patient refractory to oral anticoagulants but not to heparin. Now see the question o Urgent reversal of warfarin therapy is required when immediate hemostatic competance is necessary because of serious life threatening bleeding or when INR > 20. o In these situations FFP is the treatment of choice, which is supplemented with vit K1.