These consensus guidelines offer advice on these preventive strategies and the principles of warfarin reversal, as well as bridging therapy in the face of different clinical settings. By understanding the pharmacokinetics and pharmacodynamics of warfarin, and therefore the potential modifiers of warfarin’s effects, these bleeding risks can be minimised through preventive strategies with or without warfarin reversal.
3 It is commonly used in the community setting for indications such as uncomplicated deep vein thrombosis and stroke prophylaxis in atrial fibrillation. 1, 2 Despite these bleeding risks, warfarin use in Australia has increased between 6% and 9% per annum in the last 4 years, with current growth at about 9% per year. Major bleeding, which includes intracranial haemorrhage and bleeding leading to death or hospitalisation, has been reported in 1.2%–8.1% of patients during each year of long-term warfarin therapy. However, questions persist about the risks and management of over-anticoagulation. If necessary, warfarin therapy can be withheld 5 days before elective surgery, when the INR usually falls to below 1.5 and surgery can be conducted safely.īridging anticoagulation therapy for patients at high risk for thromboembolism should be undertaken in consultation with the relevant experts.Īnticoagulation is very effective for primary and secondary prevention of thromboembolic events. Simple dental or dermatological procedures may not require interruption to warfarin therapy. FFP should be added to Prothrombinex-HT as a source of factor VII when used for warfarin reversal. It contains factors II, IX and X, and low levels of factor VII. Prothrombinex-HT is the only PCC approved in Australia and New Zealand for warfarin reversal. To temporarily reverse the effect of warfarin when there is a need to continue warfarin therapy, vitamin K 1 should be given in a dose that will quickly lower the INR to a safe, but not subtherapeutic, range and will not cause resistance once warfarin is reinstated.
When oral vitamin K 1 is used for warfarin reversal, the injectable formulation of vitamin K 1 is preferable to tablets because of its flexible dosing this formulation can be given orally or injected. Vitamin K 1 is essential for sustaining the reversal achieved by PCC and FFP.
Immediate reversal is achieved with a prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP). To reverse the effects of warfarin, vitamin K 1 can be given. Risk factors for bleeding complications with warfarin use include age, history of past bleeding and specific comorbid conditions. Statistics,epidemiology and research designįor most warfarin indications, the target maintenance international normalised ratio (INR) is 2–3.Statistics, epidemiology and research design.
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