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