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Guidelines for the reversal of warfarin anticoagulation
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NR < 5.0
URGENCY OF REVERSAL:
1-2 DAYS: Decrease or discontinue warfarin until INR improved
12-24 HOURS: D/C warfarin, consider vitamin K 2.5 mg po,
ASAP: D/C warfarin; vitamin K 5-10 mg IV; FFP 15 ml/kg
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INR 5.0-9.0
URGENCY OF REVERSAL:
1-2 DAYS: Discontinue warfarin until INR improved
12-24 HOURS: D/C warfarin, consider vitamin K 2.5-5.0 mg po or 2.0-5.0 mg sq,
ASAP: Discontinue warfarin, vitamin K 10 mg IV; FFP; consider prothrombin complex
concentrate or recombinant factor VIIa for life threatening bleeds
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INR > 9.0
URGENCY OF REVERSAL:
1-2 DAYS: D/C warfarin, vitamin K 2.5-5.0 mg po or 2.0-5.0 mg po or sq,
12-24 HOURS: D/C warfarin, vitamin K 10 mg IV; FFP; consider prothrombin complex
concentrate or recombinant factor VIIa for life threatening bleeds
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