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

search: inr guidelines, warfarin guidelines