Initial dose: 2-5 mg PO/IV qDay for 2 days, OR 10 mg PO for 2 days in healthy individuals Prophylaxis and treatment of venous thrombosis and its extension, pulmonary embolism (PE)
ANTIDOTE FOR COUMADIN UPDATE
An update of consensus guidelines for warfarin reversal.Dosage Forms & Strengths powder for injection Tran HA, Chanilal SD, Harper PL et al.Journal of Medical Toxicology 2014: dos 10.1007 Levine M, Pizon AE, Padilla-Jones A, Ruha A-M.The Warfarin Reversal Consensus Group Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis. Baker RI, Coughlin PB, Gallus AS et al.Toxicology Conundrum 021 - Supratherapeutic INR.Toxicology Conundrum 016 - Warfarin deliberate self poisoning.Toxicology Conundrum 015 - Little Johnny and Grandad’s warfarin.Over-anticoagulation is managed as per the table in antidote section.Patients with a therapeutic requirement for anticoagulation are admitted to receive titrated doses of vitamin K.Where this management takes place will need liaison with mental health. Patients who have no therapeutic requirement for anticoagulation are given 5mg of vitamin K BD for 2 days and medically cleared.A child who ingests 0.5 mg/kg can be given 10 mg of vitamin K PO and discharged.Treatment for a raised INR with bleeding: Be aware local protocols maybe different and that close follow up of the INR should always be performed. Below is a number of tables with recommended treatments for a raised INR with and without bleeding and also a proposed regimen for titrating prothrombin complex concentrate.Those who have a therapeutic requirement must have their vitamin K administration titrated to keep the INR within range.Vitamin K is administered prophylactically to those without the therapeutic requirement who have taken an acute ingestion that will result in anticoagulation as per the risk assessment.Activated charcoal is not indicated following ingestion unless the patient has a therapeutic requirement and has taken an overdose within the past 1 hour.In patients with a therapeutic requirement an INR should be measured on presentation and every 6 hours.A normal INR at 48 hours excludes warfarin toxicity INR: If not previously on warfarin the INR will not change in the first 12 – 24 hours.Screening: 12 lead ECG, BSL, Paracetamol level.Children: A single ingestion of 2 months).Severe coagulopathy may present as bruising, petechial or puerperal rashes, gingival bleeding, epistaxis, gastrointestinal bleeding or haematuria.Active bleeding requires emergent treatment.2 mg/kg can produce a significant increase in INR within 72 hours.Patients not on warfarin who have an acute ingestion:.Patient on therapeutic warfarin have significant risk of haemorrhage, for each unit rise in INR there is a 3.5x fold risk of bleeding.
He wanted to know what had killed his cow.
In his truck, he had also brought a dead heifer and some spoiled clover hay.
ANTIDOTE FOR COUMADIN FULL
In 1933 a farmer from Deer Park showed up unannounced at the School of Agriculture and walked into a professor’s laboratory with a milk can full of blood which would not coagulate. On a trivia note warfarin was invented with the help of the Wisconsin Alumni Research Foundation (WARF) and hence the origin of the name (-arin indicating the link with coumarin). This can make the approach to treatment difficult when considering the need for therapeutic anticoagulation and expert advice maybe required. Over anticoagulation is a common problem with warfarin and acute intoxication maybe in those with or without an anticoagulation requirement.
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