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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19 Citations
Background Citations
8

19 Citations

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.
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.
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.
Coagulation and Anticoagulants
TLDR
In this chapter, the models of coagulation are described as well as the different anticoagulants used in clinical practice with their pharmacological properties.
Study of Octaplex dosing accuracy: an in vitro analysis.
TLDR
The in vitro effect of PCC dosing on international normalised ratio (INR) and factor activity suggests that INR correction alone may not accurately reflect factor activity, and lends support for weight-based dosing.
Severe Airway Obstruction due to Massive Retropharyngeal Hematoma in a Warfarin-Taking Patient with a Normal International Normalized Ratio
http://www.jtraumainj.org eISSN 2287-1683 pISSN 1738-8767 Copyright © 2021 The Korean Society of Trauma This is an Open Access article distributed under the terms of the Creative Commons Attribution…
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References

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A randomized trial comparing 1 mg of oral vitamin K with no treatment in the management of warfarin-associated coagulopathy in patients with mechanical heart valves.
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…
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.
Periprocedural anticoagulation management of patients with nonvalvular atrial fibrillation.
TLDR
The 3-month cumulative incidence of thromboembolism and bleeding among patients with AF in whom anticoagulation was temporarily interrupted for an invasive procedure was low and was not significantly influenced by bridging therapy.
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