Anticoagulation Reversal

Coumadin reversal

  • Vitamin K IV
    • 5-10 mg
    • onset takes 8-12 hrs
  • Vit K oral onset ~ 1 day
  • PCC
    • fixed dose 1500 units prob ok
    • Traditional dosing wt based
      • INR 2-4 25 units/kg to max 2500
      • INR 4-6 35 units/kg to max 3500
      • INR >6 50 units/kg to max 5000
  • FFP ~15 ml/kg dose (each unit is 250 ml)
  • Vit K reversal lasts week or more
  • PCC reversal lasts only hours

DOAC Reversal

  • PCC 50 units/kg
  • Dabigatran – idarucizimab 5 g as 2.5 g bolus x 2

Reversal for procedures

  • LP – No good evidence for it but risk of litigation due to anesthesia guidelines
  • INR under 2 is probably fine, INR under 1.5 definitely good to go

Liver disease

  • Paracentesis – Could consider PLT tx for PLT <50K
  • If really trying to correct an INR FFP probably superior to PCC