Practical management of coagulopathy associated with warfarin

Vitamin K antagonists are used by millions of patients to prevent thromboembolism. Primary care providers and specialists face clinical situations where the short term risk of bleeding or the risk of imminent thromboembolism in these patients must be assessed rapidly. In this article we provide several approaches to clinical questions that arise when patients who take vitamin K antagonists are bleeding or have an international normalised ratio (INR) above the therapeutic range. Our goal is to supplement available guidelines published by the American College of Chest Physicians and the British Committee for Standards in Haematology, which, although valuable resources, either do not directly address certain clinical scenarios or provide a range of options, suggesting that no one strategy is preferred, usually because high quality evidence is lacking.