Warfarin and Superwarfarin Toxicity Guidelines

Updated: Sep 12, 2023
  • Author: Kent R Olson, MD, FACEP; Chief Editor: David Vearrier, MD, MPH  more...
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Guidelines Summary

The American Society of Hematology (ASH) 2018 guidelines for management of venous thromboembolism include the following suggestions for management of excessive anticoagulation in patients taking warfarin [26] :

  • For patients with an international normalized ratio (INR) of > 4.5 but < 10 and without clinically relevant bleeding, temporarily stop warfarin  without adding vitamin K.
  • For patients with life-threatening bleeding and an elevated INR, discontinue warfarin and administer intravenous vitamin K plus 4-factor prothrombin complex concentrate (PCC) rather than fresh-frozen plasma (FFP).