Life-threatening bleeding (eg intracranial or major gastro-intestinal bleed)
- Stop warfarin.
- Intravenous phytomenadione (vitamin K1) by slow intravenous injection 10mg, repeated if necessary 12 hours later.
- Prothrombin complex concentrate (Beriplex®). The dose will depend on the current INR and the targeted INR. In the following table approximate doses (mL/kg body weight of the reconstituted product) required for normalisation of INR (≤1·2 within 1 hour) at different initial INR levels are given.
|Initial INR||2.0 to 3.9||4.0 to 6.0||>6.0|
|Approximate intravenous dose* (units Factor IX/kg weight)||25||35||50|
*The maximum single dose should not exceed 5000 units Factor IX, given at a maximum rate of 200 units/min, ie 8 mL/min of the 25 units/mL reconstituted solution.
The correction of the INR persists for approximately 6 to 8 hours. However, the effects of phytomenadione (vitamin K1) if administered simultaneously, are usually achieved within 4 to 6 hours. Thus, repeated treatment with Beriplex® is not usually required when phytomenadione (vitamin K1) has been administered.
- If Beriplex® is unavailable, fresh frozen plasma (15mL/kg body weight – approximately 1 litre for adult). Beriplex® and fresh frozen plasma are accessible from the Blood Transfusion Service after discussing with on-call Haematologist.