Patients sometimes present to ED or are send to ED due to over anticoagulation with warfarin
1. Is there Major/Significant bleeding?
Yes
- Resuscitate (ABCD)
- Give 5mg Vitamin K IV
- Octaplex Guide
- Treat bleeding and admit to appropriate speciality
NO & INR ≥ 8 – Ask Question 2
NO & INR < 8
- Stop or Reduce warfarin (15% reduction should reduce INR by 1)
- Consider drug interactions – interaction list
- Review in next Anticoagulation Clinic
2. Are there ANY high risk indication?
- Frail/elderly
- Recent surgery (within 1 month)
- Previous GI bleed
- Previous CVA
- Renal Failure
- Known severe liver impairment/alcohol abuse
- INR >15
ANY
- Withhold warfarin
- Consider admission to MAU
- Give 2mg Vitamin K IV
- Rpt INR in 24hr
None
- Withhold warfarin
- Give 2mg Vitamin K Oral
- May go home
- Rpt INR in 24hr (can happen AAU)
- Consider drug interactions – Interaction list
Adapted from
- Trust: Vitamin K for patients with high INR
- NICE: Oral anticoagulation
