INR Management

Question 1

management of major bleeding

Answer 1

• Stop warfarin
• Give intravenous vitamin K 5mg
• Prothrombin complex concentrate; if not available then FFP

Question 2

INR >8.0 and minor bleeding

Answer 2

• Stop warfarin
• Give intravenous vitamin K 1-3mg
• Repeat dose of vitamin K if INR still too high after 24 hours
• Restart warfarin when INR < 5.0

Question 3

INR >8.0 and no bleeding

Answer 3

• Stop warfarin
• Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
• Repeat dose of vitamin K if INR still too high after 24 hours
• Restart when INR < 5.0

Question 4

INR 5.0-8.0 and minor bleeding

Answer 4

• Stop warfarin
• Give intravenous vitamin K 1-3mg
• Restart when INR < 5.0

Question 5

INR 5.0-8.0 and no bleeding

Answer 5

• Withhold 1 or 2 doses of warfarin

- Reduce subsequent maintenance dose

Question 6

what is cryoprecipitate?

Answer 6

• Formed from supernatant of FFP.
• Rich source of Factor VIII and fibrinogen.
• Allows large concentration of factor VIII to be administered in small volume.

Question 7

what is fresh frozen plasma?

Answer 7

• Prepared from single units of blood.
• Contains clotting factors, albumin and immunoglobulin.
• Unit is usually 200 to 250ml.
• Usually used in correcting clotting deficiencies in patients with hepatic synthetic failure who are due to undergo surgery.
• Usual dose is 12-15ml/Kg-1.
• It should not be used as first line therapy for hypovolaemia.