Ver el código de «Warfarin reversal»

==Background==
*For supratheraputic INR on warfarin
*Intracranial hemorrhage is significantly increased with an INR > 4.0<ref>Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin.  Ann Intern Med.1994;120:897-902.</ref>

===Target INR===
*Vascular thrombosis (DVT, PE): 2.0-3.0
*Most mechanical heart valves: 3.0-4.5 
**Bileaflet mechanical aortic heart valves: 2.5-3.5

===Risk Factors for INR > 6.0<ref>Hylek, E et al. Acetaminophen and Other Risk Factors for Excessive Warfarin Anticoagulation. JAMA. 1998;279(9):657-662 [http://jama.jamanetwork.com/data/Journals/JAMA/4550/JOC71452.pdf PDF]</ref>===
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Risk Factor'''
| align="center" style="background:#f0f0f0;"|'''Odds Ratio'''
|-
| Malignancy||16.4
|-
| Tylenol Intake > 9100 mg/week||10
|-
| New Medication||8.5
|-
| Increased Warfarin Intake||8.1
|-
| Tylenol Intake 4550 mg - 9099 mg/week||6.9
|-
| Decrease Vitamin K intake||3.6
|-
| Acute Diarrheal Illness||3.5
|}

[[File:Supratherapeutic_inr.png|thumb|Algorithm for the management of supratherapeutic INR]]

==Treatment based on INR<ref>Holbrook A, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 [http://www.siapav.it/pdf/Chest%202012.pdf PDF]</ref>==

===INR 4.5-10 No Bleeding===
#Hold Warfarin
#Resume Warfarin at lower dose once INR therapeutic
#Not recommended to give Vitamin K

===INR >10 No Bleeding===
#Hold Warfarin
#[[Vitamin K]] 2.5mg oral

===Major Bleeding===
{{Warfarin Reversal}}

'''''Consult cardiology in conjunction with hematology if patient has prosthetic valve'''''

==See Also==
*[[Coagulopathy (Main)]]
*[[Warfarin (Coumadin)]]
*[[Anticoagulant reversal for life-threatening bleeds]]

==Video==
{{#widget:YouTube|id=Qmgq0BvvZ7U}}

==References==
<references/>

[[Category:Pharmacology]]
[[Category:Heme/Onc]]
[[Category:Toxicology]]