Practical management of coagulopathy associated with warfarin

@article{Garcia2010PracticalMO,
  title={Practical management of coagulopathy associated with warfarin},
  author={David A. Garcia and Mark Andrew Crowther and Walter Ageno},
  journal={BMJ : British Medical Journal},
  year={2010},
  volume={340}
}
When choosing a management strategy for a patient who is being treated with a vitamin K antagonist and presents with an INR outside the therapeutic range, consider the risk of both bleeding and thrombosis 
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20 Citations

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Citation Type

Treatment of warfarin-associated coagulopathy with vitamin K
TLDR
Despite development of new oral anticoagulant therapy compounds, warfarin will probably retain a prominent role in thromboembolism management for several years to come.
Non-Obvious, Post-Traumatic, Life-Threatening Bleeding in Two Elderly Patients
TLDR
Two cases are described in which inaccurate diagnoses lead to inadequate treatment of major bleeding in patients receiving anticoagulant therapy.
Practical issues with vitamin K antagonists: elevated INRs, low time-in-therapeutic range, and warfarin failure
TLDR
An overview of the most commonly used vitamin K antagonists is provided and the importance of assessing quality of anticoagulation with respect to clinical outcomes is discussed, drawing on evidence where applicable and expert opinion where evidence is limited.
How to effectively manage the event of bleeding complications when using anticoagulants
TLDR
Premarketing studies are ongoing on new antidotes (idarucizumab, andexanet, aripazine), which appear to be suitable for the treatment of DOAC-induced life-threatening hemorrhage, which may partly neutralize low-molecular-weight heparins.
Simultaneous intrahepatic and subgaleal hemorrhage in antiphospholipid syndrome following anticoagulation therapy.
TLDR
Intrahepatic hemorrhage is a very rare complication of warfarin, and an 18-year-old woman with antiphospholipid syndrome experienced intra hepatic and subgaleal hemorrhage although she did not have any risk factors for bleeding or instability of the international normalized ratio control.
New oral anticoagulants: how safe are they?
TLDR
This article has compared warfarin with the commonly used new oral anticoagulants to determine whether their use is safe in Sri Lanka.
Anti-coagulation Drug Warfarin Contributes to Severe Adverse Outcomes in Prolonged Unsupervised Use: A Double-edged Sword
TLDR
A 58-year-old Caucasian male presented with non-traumatic acute quadriplegia with cord compression starting at the 3rd cervical (C3) level and continuing throughout the entire spinal cord and it became evident that his patient had been on a prolonged and unsupervised warfarin (Coumadin) regimen for congestive heart failure without primary care follow-up or routine laboratory testing.
When to stop, how to reverse, and when to restart antithrombotic drugs periendoscopically in nonvariceal upper gastrointestinal bleeding
The misconceptions about warfarin.
  • J. Thachil
  • Medicine
    QJM : monthly journal of the Association of Physicians
  • 2011
TLDR
The role of anti-platelet agents, non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors in worsening warfarin-related bleeding needs emphasis.
Diagnosis and management of the antiphospholipid syndrome
TLDR
This complicated and intriguing syndrome is introduced, and basic guiding principles for the recognition, diagnosis, and management of affected patients are provided.
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...

References

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Care of Patients Receiving Long-Term Anticoagulant Therapy
A 75-year-old man with diabetes mellitus is found to have chronic atrial fibrillation, and warfarin therapy is begun for the prevention of thromboembolic stroke. How should the anticoagulant therapy…
Preventing and managing bleeding complications in anticoagulated patients: a case based approach.
Randomized, Placebo‐Controlled Trial of Oral Phytonadione for Excessive Anticoagulation
Study Objective. To compare the efficacy of managing excessive anticoagulation in the absence of bleeding by either omitting warfarin therapy alone or administering oral phytonadione in addition to…
Treatment of warfarin-associated coagulopathy with oral vitamin K: a randomised controlled trial
Prevention and treatment of bleeding complications in patients receiving vitamin K antagonists, part 2: Treatment
TLDR
Clinicians are still required to initiate and monitor vitamin K antagonists while mitigating the risks of bleeding and thrombosis, and recommen-dations designed to assist clinicians in estimating and managing bleeding risk in patients receiving oral vitamin Kantagonists are provided.
Role of prothrombin complex concentrates in reversing warfarin anticoagulation: A review of the literature
TLDR
A review of the published literature over the last 30 years found that PCCs offer a rapid and specific method for replacing vitamin K‐dependent clotting factors and restoring normal hemostasis in the context of over‐coagulation.
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TLDR
This article describes the antithrombotic effect of the VKAs, the monitoring of anticoagulation intensity, and the clinical applications of VKA therapy and provides specific management recommendations.
Treatment of coumarin‐associated coagulopathy: a systematic review and proposed treatment algorithms
TLDR
Vitamin K therapy is an effective treatment for INR prolongation in patients with coumarin‐associated coagulopathy; coagulation factor replacement is required, in addition, in Patients with major bleeding or with indication for immediate correction of their INR.
Low-dose oral vitamin K reliably reverses over-anticoagulation due to warfarin.
TLDR
In patients receiving warfarin who have asymptomatic excessive prolongations in their INR results, 1 mg of oral vitamin K reliably reduces the INR to the therapeutic range within 24 h, suggesting this therapy is more convenient, less expensive, and might be safer than parenteral vitamin K.
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