Warfarin-Induced Coagulopathy - Correction

• Decision to proceed should be based on the clinical status of the patient and risk/benefit analysis
• Options:
  • Vitamin K: subcutaneous < IV = PO
    • Given anaphylaxis risk with IV, PO preferred, unless bleeding is life-threatening
    • For more rapid absorption, can give the IV preparation orally
  • FFP: Contains all coagulation factors from one unit of blood
    • Intrinsic INR ~1.3, duration of effect 6-8 hours, volume 250 cc
    • Hemostasis is achieved with 1/3 of normal factor activity
    • Thus 4 units FFP typically required (plasma volume in 70kg male is ~3.5L)
  • Cryo-poor plasma: Depleted of cold-insoluble proteins (VIII, XIII, vWF, fibrinogen, fibronectin, i.e. cryoprecipitate)
    • Given that it contains Vit K dependent factors, can be used to reverse warfarin coagulopathy

(Christopher Woo MD, 11/1/10)