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Warfarin (Raised INR (Major bleeding (Stop warfarin (Vit K IV (Onset of…

- - - - Vit K IV
        
        Onset of action = 6h
        
        Oral is as efficacious as IV
        
        Oral Vit K can → prolonged anticoagulant resistance
        
        If continuing anticoagulation, avoid if possible
      - Prothrombin complex concentrate
        
         Factors 2, 7, 9 and 10
        
         Immediate reversal of anticoagulation
        
         Temporary effect: give c¯ Vit K
        
         Risk of VTE and v. expensive
      - FFP 15ml/kg if unavailable
- - - - Duration Cause known: 6wks No cause: 3mo
    - - Duration Cause known: 3mo
        No cause: 6mo
    - - Duration Cause known: 3mo
        No cause: 6mo
    - - AF
      - Mitral valve disease
      - Recurrent DVT/PE INR 2.5 OR 3.5 if on W
  - - - Anti-phospholipid
        syn.
      - Metal valves
- - - - Day 8: check INR and adjust dose according to table
        
        Day 8: check INR every 4 days and dose accordingly
        
        OPD: warfarinisation over 3-4wks is safe and effective
- - - - W-
        
        OCP
        
        Phenytoin
        
        Barbiturates
        
        St. John’s Wart
        
        Rifampicin
        
        CBZ