UK guidelines for warfarin reversal21
| Clinical situation | Action |
|---|---|
| FFP, fresh frozen plasma; INR, international normalised ratio; IV, intravenous; PCC, prothrombin complex concentrate. | |
| Major bleeding | Stop warfarin |
| Vitamin K (5 mg IV or oral) | |
| PCC (50 U/kg) or FFP (15 ml/kg) | |
| Caution: FFP may not fully reverse the effect of warfarin—for example, factor IX does not rise >20% post FFP (not reflected in INR) | |
| Non-major bleeding | |
| INR <6.0 | Omit warfarin |
| INR >6.0 to <8.0 | Omit warfarin |
| No/minor bleeding | |
| INR >8.0 | Omit warfarin |
| INR >8.0 + other risk factors for bleeding | Omit warfarin + 0.5–2.5 mg vitamin K (IV or oral) |