Practical management of coagulopathy associated with warfarin

Thanks for the timely article on the reversal of warfarin in effect
in clinical practice.It is still a very grey area when it comes to
difficult clinical situations especially in somebody with a prosthetic
heart valve and moderate bleeding.If the bleeding is life threatening
obviously there is no choice but to reverse the high INR.Warfarin is a
nightmare especially for junior doctors and nurses who are most involved
in the use of warfarin in inpatients. The use of prothrombin complex has
altered the reversal of warfarin effect as it is very short acting and
better than the fresh frozen plasma.The interesting point is that the
patient still needs Vitamin K for a much more uniform reversal. And again
higher doses of vitamin K might lead to prolonged suppression of INR and
may have a procoagulant effect.The common scenario is that of a prosthetic
valve patient getting ten mg of vitamin K for a high INR.And in some
instances vitamin K is given intramuscularly leading to a big
haematoma.Oral vitamin K is still the preferred route for minor bleeds but
for some elderly patients,alcoholics,inflammatory disease and heart
failure patients intravenous vitamin K is better.I am not sure when the
new anticoagulant comes in there will be an antagonist? We will have to
wait and see.

Competing interests:
None declared